t* <r C 1 C O S~
: ^3tP--N£OTTRTAiri4E^T^ STEM
AND PROGENITOR CELLS OF THE BLOOD
TABLE OF CONTENTS
Page
1Q 1. Introduction , 6
2. Background of the Invention 6
2.1. Hematopoietic Stem and Progenitor Cells.... 6
2.2. Reconstitution of the Hematopoietic
System 9
15 2.3. Cryopreservation of Cells 13
2.4. Gene Therapy 14
3. Summary of the Invention 16
3.1. Definitions 16
4. Description of the Figures. 19
2Q 5. Detailed Description of the Invention 20
5.1. Isolation of Fetal or Neonatal
Hematopoietic Stem and Progenitor Cells.... 25
5.1.1. Collection of Neonatal Blood 26
5,1.1.1. Volume 26
2 5 5.1.1.2. Preferred Aspects 28
5.1.1.2.1. Collection Kit 28
5.1.1.2.2. Vaginal Delivery of the
Term Infant 29
5.1.1.2.3. Other Circumstances of
3 q Birth and Delivery 30
5.1.1.2.3.1. Premature Birth 3 0
5.1.1.2.3.2. Multiple Births 30
5.1.1.2.3.3. Caesarian Delivery.. 31
5.1.1.2.3.4. Complicated Delivery 31
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5. 1.1.2. 3.5. Abnormal Placenta... 3 2
5.1.1.2.3.6. Collection from the
Delivered Placenta.. 3 2
5
5.1.1.2.3.7. Medical Conditions
of the Mother 3 2
5.1.1.2.3.8. Unplanned Delivery.. 3 3
5.1.1.2.4. Recordation of Data 3 3
5.1.2. Inspection and Testing of Neonatal
10 Blood 34
5.1.3. Optional Procedures 3 6
5.1.3.1. Enrichment for Hematopoietic
Stem and Progenitor Cells:
Cell Separation Procedures.... 37
15
5.1.3.2. In Vitro Cultures of Hemato-
poietic Stem and Progenitor
Cells 43
5.2. Cryopreservation 4 3
5.3. Recovering Stem and Progenitor Cells from
zu the Frozen State 4 7
5.3.1. Thawing 4 7
5.3.2. Optional Procedures 4 7
5.4. Examination of Cells Recovered for
Clinical Therapy 48
25 5.4.1. Identity Testing 49
5.4.2. Assays for Stem and Progenitor
Cells 49
5.5. Hematopoietic Reconstitution 50
5.6. Therapeutic Uses 51
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5.6.1. Diseases Resulting from a Failure
or Dysfunction of Normal Blood
Cell Production and Maturation 56
5.6.2. Hematopoietic Malignancies 59
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5.6.3. Malignant Solid Tumors of Non-
Hematopoietic Origin 59
5.6.4. Autoimmune Disorders / 60
5
5.6.5. Gene Therapy 61
5.6.6. Miscellaneous Disorders Involving
Immune Mechanisms 64
5.7 Generation and Use of Hematopoietic Stem
and Progenitor Cell Progeny 65
6. Examples 66
6.1. Collection of Human Umbilical Cord Blood
and Placental Blood 66
6.2. Hematopoietic Stem and Progenitor Cells in
Collected Cord Blood 68
15
6.3. Enrichment for Human Hematopoietic Stem
and Progenitor Cells: Cell Separation
Procedures 75
6.3.1. Density Separations 76
6.3.2. Adherence/Non-Adherence Separation. 80
20
6.4. Cryopreservation of Cord Blood Stem and
Progenitor Cells 81
6.5. Cell Thawing 82
6.6. Human Hematopoietic Stem and Progenitor
Cell Assays 8 3
25
6.6.1. CFU-GM Assay 8 4
6.6.1.1. Preparation of McCoy's
5 A Medium 86
6.6.1.2. Preparation of Human 5637
Urinary Bladder Carcinoma
30
Cell Line Conditioned
Medium 8 7
6.6.1.3. Preparation of Murine
Pokeweed Mitogen Spleen
Cell Conditioned Medium. . 88
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6.6.2. BFU-E-2 and BFU-E-1/CFU-GEMM Assay.. 89
6.6.2.1. Preparation of 2.1% Methyl
Cellulose 91
5
6.6.2.2. Preparation of Hemin 92
6.6.2.3. Preparation of Iscove's
Modified Dulbecco's
Medium 92
6.6.3. Stem Cell Colony Forming Unit
10
Assay 93
6.6.4. Assay of the Proliferative Status
of Stem and Progenitor Cells 9 3
6.7. Recovery After Freeze-Thawing of Human
Hematopoietic Progenitor Cells
15
Derived from Cord Blood 9 5
6.8. Calculations of the Reconstituting Potential
of Cord Blood 98
6.9. In Vitro Culture Conditions for Hematopoietic
Stem and Progenitor Cells 100
20
6.10. Mouse Dissection Protocols 100
6. 10.1. Bone Marrow Dissection 101
6.10.2. Spleen Dissection 102
6.11. Hematopoietic Reconstitution of Adult
Mice with Syngeneic Fetal or Neonatal
25 Stem Cells 103
6.11.1. Hematopoietic Reconstitution
of Lethally-Irradiated Mice
with Stem Cells in Blood of the
Near-Term Fetus 103
30 ....
6.11.2. Hematopoietic Reconstitution
of Mice with a Lesser Volume of
Near-Term Fetal Blood But Not
with Adult Blood 105
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6.11.3. Hematopoietic Reconstitution
with Blood of Newborn Mice in
Volumes as Low as Ten Microliters.. 108
6.11.4. Hematopoietic Reconstitution
with Blood of Newborn Mice in
Volumes of 10 or 15 Microliters.... 110
6.12 Hematopoietic Reconstitution For Treatment
of Fanconi's Anemia Ill
6.13. Flowchart: Description of a Service 114
This applicat i^n^^ a Continuation - in - part of
fob**
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copendin g U.S. — application Serial No. — 07/119 , 746 -? — £iied A f , <s 0i
N o vember 12, — 1 9 0 -7- , which is incorporated by reference herein in
its entirety. **eLd
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1. INTRODUCTION
The present invention is directed to hematopoietic stem
and progenitor cells of neonatal or fetal blood, that are
cryopreserved, and the therapeutic uses of such stem and
progenitor cells upon thawing. Such cells can be
therapeutically valuable for hematopoietic reconstitution in
patients with various diseases and disorders. In a preferred
embodiment, neonatal cells that have been cryopreserved and
thawed, can be used for autologous (self) hematopoietic
reconstitution.
The invention also relates to methods for collection and
cryopreservation of the neonatal and fetal stem and
progenitor cells of the invention,
2, BACKGROUND OF THE INVENTION
2,1, HEMATOPOIETIC STEM AND PROGENITOR CELLS
The morphologically recognizable and functionally
capable cells circulating in blood include erythrocytes,
neutrophilic, eosinophilic, and basophilic granulocytes, B-,
T-, nonB-, non T-lymphocytes , and platelets. These mature
cells derive from and are replaced, on demand, by morphologi-
cally recognizable dividing precursor cells for the
respective lineages such as erythroblasts for the erythrocyte
series, myeloblasts, promyelocytes and myelocytes for the
granulocyte series, and megakaryocytes for the platelets.
The precursor cells derive from more primitive cells that can
simplistically be divided into two major subgroups: stem
cells and progenitor cells (for review, see Broxmeyer, H.E.,
1983, "Colony Assays of Hematopoietic Progenitor Cells and
Correlations to Clinical Situations," CRC Critical Reviews in
Oncology/Hematology 1 (3) : 227-257) . The definitions of stem
and progenitor cells are operational and depend on func-
tional, rather than on morphological, criteria. Stem cells
have extensive self-renewal or self-maintenance capacity
(Lajtha, L.G., 1979, Differentiation 14:23), a necessity
since absence or depletion of these cells could result in the
complete depletion of one or more cell lineages, events that
would lead within a short time to disease and death. Some of
one stem cells differentiate upon need, but some stem cells
or their daughter cells produce other stem cells to maintain
the precious pool of these cells. Thus, in addition to
maintaining their own kind, pluripotential stem cells are
capable of differentiation into several sublines of
progenitor cells with more limited self-renewal capacity or
no self -renewal capacity. These progenitor cells ultimately
give rise to the morphologically recognizable precursor
cells. The progenitor cells are capable of proliferating and
differentiating along one, or more than one, of the myeloid
differentiation pathways (Lajtha, L.G. (Rapporteur), 1979,
Blood Cells 5:447) .
Stem and progenitor cells make up a very small percent-
age of the nucleated cells in the bone marrow, spleen, and
blood. About ten times fewer of these cells are present in
the spleen relative to the bone marrow, with even less
present in the adult blood. As an example, approximately one
in one thousand nucleated bone marrow cells is a progenitor
cell; stem cells occur at a lower frequency. These
progenitor and stem cells have been detected and assayed for
by placing dispersed suspensions of these cells into irradi-
ated mice, and noting those cells that seeded to an organ
such as the spleen and which found the environment conducive
to proliferation and differentiation. These cells have also
been quantified by immobilizing the cells outside of the body
in culture plates (in vitro ) in a semi-solid support medium
such as agar, methylcellulose, or plasma clot in the presence
of culture medium and certain defined biomolecules or cell
populations which produce and release these molecules. Under
the appropriate growth conditions, the stem or progenitor
cells will go through a catenated sequence of proliferation
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and differentiation yielding mature end stage progeny, which
thus allows the determination of the cell type giving rise to
the colony. If the colony contains granulocytes, macropha-
ges, erythrocytes, and megakaryocytes (the precursors to
platelets, , then the cell giving rise to them would have been
a pluripotential cell. To determine if these cells have
self -renewal capacities, or sternness, and can thus produce
more of their own kind, cells from these colonies can be
replated in vivo or in vitro . Those colonies, which upon
replating into secondary culture plates, give rise to more
colonies containing cells of multilineages, would have
contained cells with some degree of sternness. The stem cell
and progenitor cell compartments are themselves heterogeneous
with varying degrees of self-renewal or proliferative
capacities. A model of the stem cell compartment has been
proposed based on the functional capacities of the cell
(Hellman, S., et al., 1983, J. Clin. Oncol. 1:227-284).
Self -renewal would appear to be greater in those stem cells
with the shortest history of cell division, and this self-
renewal would become progressively more limited with
subsequent division of the cells.
A human hematopoietic colony-forming cell with the
ability to generate progenitors for secondary colonies has
been identified in human umbilical cord blood (Nakahata, T.
and Ogawa, M. , 1982, J . Clin. Invest. 70:1324-1328). In
addition, hematopoietic stem cells have been demonstrated in
human umbilical cord blood, by colony formation, to occur at
a much higher level than that found in the adult (Prindull,
G., et al., 1978, Acta Paediatr. Scand. 67:413-416; Knudtzon,
S., 1974, Blood 43 (3) : 357-361) . The presence of circulating
hematopoietic progenitor cells in human fetal blood (Linch,
D.C., et al., 1982, Blood 59 ( 5 ): 976-979 ) and in cord blood
(Fauser, A. A. and Messner, H.A. , 1978, Blood 52 (6) : 1243-1248)
has also been shown. Human fetal and neonatal blood has been
reported to contain megakaryocyte and burst erythroblast
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progenitors (Vainchenker, W. , et al., 1979, Blood Cells
5:15-42), with increased numbers of erythroid progenitors in
human cord blood or fetal liver relative to adult blood
(Hassan, M.W., et al., 1979, Br. J. Haematol. 41:477-484;
Tchernia, G., et ...1., 1981, J. Lab. Clin. Med. 97(3) :322-
3 31) . Studies have suggested some differences between cord
blood and bone marrow cells in the characteristics of CFU-GM
(colony forming unit-granulocyte, macrophage) which express
surface la antigens (Koizumi, S., et al - , 1982, Blood
60(4) : 1046-1049) .
suspensions comprising human stem and progenitor cells and
methods for isolating such suspensions, and the use of the
cell suspensions for hematopoietic reconstitution.
2-2. RECONSTITUTION OF THE HEMATOPOIETIC SYSTEM
Reconstitution of the hematopoietic system has been
accomplished by bone marrow transplantation. Lorenz and
coworkers showed that mice could be protected against lethal
irradiation by intravenous infusion of bone marrow (Lorenz,
E., et al., 1951, J. Natl. Cancer Inst. 12:197-201). Later
research demonstrated that the protection resulted from
colonization of recipient bone marrow by the infused cells
(Lindsley, D.L., et al., 1955, Proc. Soc. Exp. Biol. Med.
90:512-515; Nowell, P.C., et al., 1956, Cancer Res. 16:258-
261; Mitchison, N.A. , 1956, Br. J. Exp. Pathol. 37:239-247;
Thomas, E. D. , et al., 1957, N. Engl. J. Med. 257:491-496).
Thus, stem and progenitor cells in donated bone marrow can
multiply and replace the blood cells responsible for
protective immunity, tissue repair, clotting, and other
functions of the blood. In a successful bone marrow
transplantation, the blood, bone marrow, spleen, thymus and
other organs of immunity are repopulated with cells derived
from the donor.
10
U.S. Patent No. 4,714,680 discloses cell
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U.S. Patent No, 4,721,096 by Naughton et al. discloses a
method of hematopoietic reconstitution which comprises
obtaining and cryopreserving bone marrow, replicating the
bone marrow cells in vitro , and then infusing the cells into
a patient.
Bone marrow has been used with increasing success to
treat various fatal or crippling diseases, including certain
types of anemias such as aplastic anemia (Thomas, E.D., et
al., Feb. 5, 1972, The Lancet, pp. 284-289), Fanconi's anemia
(Gluckman, E. , et al., 1980, Brit. J. Haematol. 45:557-564;
Gluckman> E. , et al., 198 3, Brit. J. Haematol. 54:431-440;
Gluckman, E. , et al., 1984, Seminars in Hematology : 21
(l):20-26), immune deficiencies (Good, R.A- , et al., 1985,
Cellular Immunol. 82:36-54), cancers such as lymphomas or
leukemias (Cahn, J.Y., et al., 198 6, Brit. J. Haematol.
63:457-470; Blume, K.J. and Forman, S.J., 1982, J. Cell.
Physiol. Supp. 1:99-102; Cheever, M-A. , et al., 1982, N.
Engl. J. Med. 307 (8) : 479-481) , carcinomas (Blijham, G. , et
al., 1981, Eur. J. Cancer 17 (4) : 433-441) , various solid
tumors (Ekert, H. , et al., 1982, Cancer 49:603-609; Spitzer,
G., et al., 1980, Cancer 45:3075-3085), and genetic disorders
of hematopoiesis. Bone marrow transplantation has also
recently been applied to the treatment of inherited storage
diseases (Hobbs, J.R., 1981, Lancet 2:735-739), thalassemia
major (Thomas, E.D., et al. , 1982, Lancet 2:227-229), sickle
cell disease (Johnson, F.J., et al., 1984, N. Engl. J. Med.
311:780-783), and osteopetrosis (Coccia, P.F., et al., 1980,
N. Engl. J. Med. 302:701-708) (for general discussions, see
Storb, R. and Thomas, E.. D. , 1983, Immunol. Rev. 71:77-102;
O'Reilly, R. , et al., 1984, Sem. Hematol . 21(3) : 188-221;
1969, Bone-Marrow Conservation, Culture and Transplantation,
Proceedings of a Panel, Moscow, July 22-26, 1968,
International Atomic Energy Agency, Vienna; McGlave, P.B., et
al., 1985, in Recent Advances in Haematology, Hoffbrand,
A.V. , ed., Churchill Livingstone, London, pp. 171-197).
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Present use of bone marrow transplantation is severely
restricted, since it is extremely rare to have perfectly
matched (genetically identical) donors, except in cases where
an identical twin is available or where bone marrow cells of
a patient in remission are stored in a viable frozen state.
Even in such an autologous system, the danger due to
undetectable contamination with malignant cells, and the
necessity of having a patient healthy enough to undergo
marrow procurement, present serious limitations. (For
reviews of autologous bone marrow transplantation, see
Herzig, R.H. , 1983, in Bone Marrow Transplantation, Weiner,
R.S,, et al., eds. , The Committee On Technical Workshops,
American Association of Blood Banks, Arlington, Virginia;
Dicke, K.A. , et al. , 1984, Sem. Hematol. 21 (2 ): 109-122 ;
Spitzer, G., et al., 1984, Cancer 54 (Sept. 15 Suppl . ) : 1216-
122 5) . Except in such autologous cases, there is an
inevitable genetic mismatch of some degree, which entails
serious and sometimes lethal complications. These
complications are two-fold. First, the patient is usually
immunologically incapacited by drugs beforehand, in order to
avoid immune rejection of the foreign bone marrow cells (host
versus graft reaction) . Second, when and if the donated bone
marrow cells become established, they can attack the patient
(graft versus host disease) , who is recognized as foreign.
Even with closely matched family donors, these complications
of partial mismatching are the cause of substantial mortality
and morbidity directly due to bone marrow transplantation
from a genetically different individual.
Peripheral blood has also been investigated as a source
of stem cells for hematopoietic reconstitution (Nothdurtt,
W. , et al., 1977, Scand. J. Haematol. 19:470-481; Sarpel,
S.C., et al., 1979, Exp. Hematol. 71:113-120; Ragharachar, A. ,
et al., 1983, J. Cell. Biochem. Suppl. 7A:78; Juttner, C.A. ,
et al., 1985, Brit. J. Haematol. 61:739-745; Abrams, R.A., et
al., 1983, J . Cell. Biochem. Suppl. 7A:53; Prummer, O., et
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al-, 1985, Exp. Hematol . 13:891-898). In some studies,
promising results have been obtained for patients with
various leukemias (Reiffers, J., et al. , 1986, Exp. Hematol.
14:312-315 (using cryopreserved cells); Goldman, J.M., et
al., 1980, Br. J. Haematol. 45:223-231; Tilly, H., et al.,
July 19, 1986, The Lancet, pp. 154-155; see also To, L.B. and
Juttner, C.A. , 1987, Brit. J. Haematol. 66: 285-288, and
references cited therein); and with lymphoma (Korbling, M. ,
et al., 1986, Blood 67:529-532). It has been implied that
the ability of autologous peripheral adult blood to
reconstitute the hematopoietic system, seen in some cancer
patients, is associated with the far greater numbers of
circulating progenitor cells in the peripheral blood produced
after cytoreduction due to intensive chemotherapy and/or
irradiation (the rebound phenomenon) (To, L.B. and Juttner,
C.A,, 1987, Annot. , Brit. J. Haematol. 66:285-288; see also
1987, Brit. J. Haematol. 67:252-253, and references cited
therein) . Other studies using peripheral blood have failed
to effect reconstitution (Hershko, C, et al., 1979, The
Lancet 1:945-947; Ochs, H.D., et al., 1981, Pediatr. Res.
15(4 Part 2) :601) .
Studies have also investigated the use of fetal liver
cell transplantation (Cain, G.R., et al., 1986,
Transplantation 41(l):32-25; Ochs, H.D., et al., 1981,
Pediatr. Res. 15(4 part 2):601; Paige, C.J., et al., 1981, J.
Exp. Med. 153:154-165; Touraine, J.L., 1980, Excerpta Med.
514:277; Touraine, J.L., 1983, Birth Defects 19:139; see also
Good, R.A., et al., 1983, Cellular Immunol. 82:44-45 and
references cited therein) or neonatal spleen cell
transplantation (Yunis, E. J. , et al., 1974, Proc. Natl. Acad.
Sci. U.S.A. 72:4100) as stem cell sources for hematopoietic
reconstitution. Cells of neonatal thymus have also been
transplanted in immune reconstitution experiments (Vickery,
A.C., et al., 1983, J. Parasitol. 69 (3) : 478-485 ; Hirokawa,
K. , et al., 1982, Clin. Immunol. Immunopathol . 22:297-304),
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2.3. CRYQ PRESERVATION OF CELLS
Freezing is destructive to most living cells. Upon
cooling, as the external medium freezes, cells equilibrate by
losing water, thus increasing intracellular t solute
concentration. Below about 10-15*C, intracellular freezing
will occur. Both intracellular freezing and solution effects
are responsible for cell injury (Mazur, P., 1970, Science
168:939-949). It has been proposed that freezing destruction
from extracellular ice is essentially a plasma membrane
injury resulting from osmotic dehydration of the cell
(Meryman, H.T., et al . , 1977, Cryobiology 14:287-302).
Cryoprotective agents and optimal cooling rates can
protect against cell injury. Cryoprotection by solute
addition is thought to occur by two potential mechanisms:
colligatively , by penetration into the cell, reducing the
amount of ice formed; or kinetically, by decreasing the rate
of water flow out of the cell in response to a decreased
vapor pressure of external ice (Meryman, H.T. , et al., 1977,
Cryobiology 14:287-302). Different optimal cooling rates
have been described for different cells. Various groups have
looked at the effect of cooling velocity or cryopreservatives
upon the survival or transplantation efficiency of frozen
bone marrow cells or red blood cells (Lovelock, J.E. and
Bishop, M.W.H., 1959, Nature 183:1394-1395; Ashwood-Smith ,
M.J., 1961, Nature 190:1204-1205; Rowe, A.W. and Rinfret,
A. P., 1962, Blood 20:636; Rowe, A.W. and Fellig, J., 1962,
Fed. Proc. 21:157; Rowe, A.W. , 1966, Cryobiology 3(1) : 12-18;
Lewis, J. P., et al., 1967, Transfusion 7(l):17-32; Rapatz ,
G. , et al., 1968, Cryobiology 5(1): 18-25; Mazur, P., 1970,
Science 168:939-949; Mazur, P., 1977, Cryobiology 14:251-272;
Rowe, A.W. and Lenny, L.L., 1983, Cryobiology 20:717; Stiff,
P.J., et al., 1983, Cryobiology 20:17-24; Gorin, N.C., 1986,
Clinics in Haematology 15 (1) : 19-48) •
The successful recovery of human bone marrow cells after
long-term storage in liquid nitrogen has been described
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(1983, American Type Culture Collection, Quarterly Newsletter
3(4) :1). In addition, stem cells in bone marrow were shown
capable of withstanding cryopreservation and thawing without
significant cell death, as demonstrated by the ability to
form equal numbers of mixed myeloid-erythroid colonies in
vitro both before and after freezing (Fabian, I., et al.,
1982, Exp, Hematol. 10 ( 1) : 119-122) . The cryopreservation and
thawing of human fetal liver cells (Zuckerman, A.J., et al.,
1968, J . Clin. Pathol. (London) 21 (1) : 109-110) , fetal
myocardial cells (Robinson, D.M. and Simpson, J.F., 1971, In
Vitro 6(5):378), neonatal rat heart cells (Alink, G.M. , et
al., 1976, Cryobiology 13:295-304), and fetal rat pancreases
(Kemp, J. A., et al., 1978, Transplantation 26 (4 ): 260-264)
have also been reported.
2.4. GENE THERAPY
Gene therapy refers to the transfer and stable insertion
of new genetic information into cells for the therapeutic
treatment of diseases or disorders. The foreign gene is
transferred into a cell that proliferates to spread the new
gene throughout the cell population. Thus stem cells, or
pluripotent progenitor cells, are usually the target of gene
transfer, since they are proliferative cells that produce
various progeny lineages which will potentially express the
foreign gene.
Most studies in gene therapy have focused on the use of
hematopoietic stem cells. High efficiency gene transfer
systems for hematopoietic progenitor cell transformation have
been investigated for use (Morrow, J.F., 197 6, Ann. N.Y.
Acad. Sci. 265:13; Salzar, W. , et al., 1981, in Organization
and Expression of Globin Genes, A.R. Liss, Inc., New York, p.
313; Bernstein, A., 1985, in Genetic Engineering: Principles
-and Methods, Plenum Press, New York, p. 235; Dick, J.E., et
al., 1986, Trends in Genetics 2:165). Reports on the
development of viral vector systems indicate a higher
-In-
efficiency of transformation than DNA-mediated gene transfer
procedures ( e.g. , CaP0 4 precipitation and DEAE dextran) and
show the capability of integrating transferred genes stably
in a wide variety of cell types. Recombinant retrovirus
vectors have been widely used experimentally to transduce
hematopoietic stem and progenitor cells* Genes that have
been successfully expressed in mice after transfer by
retrovirus vectors include human hypoxanthine phosphoribosyl
transferase (Miller, A., et al., 1984, Science 255:630).
Bacterial genes have also been transferred into mammalian
cells, in the form of bacterial drug resistance gene
transfers in experimental models. The transformation of
hematopoietic progenitor cells to drug resistance by
eukaryotic virus vectors, has been accomplished with recom-
binant retrovirus-based vector systems (Hock, R.A. and
Miller, A.D., 1986, Nature 320:275-277; Joyner, A, , et al-,
1983, Nature 305:556-558; Williams, D.A- , et al-, 1984,
Nature 310:476-480; Dick, J.E. , et al., 1985, Cell 42:71-79);
Keller, G. , et al,, 1985, Nature 318:149-154; Eglitis, M. , et
al., 1985, Science 230:1395-1398). Recently, adeno-associa-
ted virus vectors have been used successfully to transduce
mammalian cell lines to neomycin resistance (Hermonat, P.L.
and Muzyczka, N., 1984, supra ; Tratschin, J.-D-, et al-,
1985, Mol- Cell- Biol- 5:3251)- Other viral vector systems
that have been investigated for use in gene transfer include
papovaviruses and vaccinia viruses (see Cline, M-J., 1985,
Pharmac- Ther. 29:69-92).
Other methods of gene transfer include microinjection,
electroporation, liposomes, chromosome transfer, and
transfection techniques (Cline, M.J-, 1985, supra ) - Salser
et al. used a calcium-precipitation transfection technique to
transfer a methotrexate-resistant dihydrof olate reductase
(DHFR) or the herpes simplex virus thymidine kinase gene, and
a human globin gene into murine hematopoietic stem cells. In
vivo expression of the DHFR and thymidine kinase genes in
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stem cell progeny was demonstrated (Salser, W. , et al. , 1981,
in Organization and Expression of Globin Genes, Alan R. Liss,
Inc., New York, pp. 313-334).
Gene therapy has also been investigated in murine models
with the goal of enzyme replacement therapy. Thus, normal
stem cells from a donor mouse have been used to reconstitute
the hematopoietic cell system of mice lacking beta-
glucuronidase (Yatziv, S., et al., 1982, J. Lab. Clin. Med.
90:792-797). Since a native gene was being supplied, no
recombinant stem cells (or gene transfer techniques) were
necessary.
3. SUMMARY OF THE INVENTION
The present invention is directed to hematopoietic stem
and progenitor cells of neonatal or fetal blood, that are
cryopreserved, and the therapeutic uses of such stem and
progenitor cells upon thawing. In particular, the present
invention relates to the therapeutic use of fetal or neonatal
stem cells for hematopoietic (or immune) reconstitution.
Hematopoietic reconstitution with the cells of the invention
can be valuable in the treatment or prevention of various
diseases and disorders such as anemias, malignancies,
autoimmune disorders, and other immune dysfunctions and
deficiencies • In another embodiment, fetal or neonatal
hematopoietic stem and progenitor cells which contain a
heterologous gene sequence can be used for hematopoietic
reconstitution in gene therapy.
In a preferred embodiment of the invention, neonatal or
fetal blood cells that have been cryopreserved and thawed can
be used for autologous (self) reconstitution.
The invention also relates to methods of collection and
cryopreservation of the neonatal and fetal stem and
progenitor cells of the invention.
-17-
3.1. DEFINITIONS
As used herein, the following abbreviations will have
the meanings indicated:
acid-citrate dextrose
burst-forming unit-erythroid. An
hematopoietic progenitor cell which is
capable of producing a colony of
erythroid progeny cells in semi-solid
medium.
ACD
5
BFU-E
10
15
20
BFU-E-1 = an early erythroid progenitor cell,
capable of producing a colony of
erythroid progeny cells in semi-solid
medium upon stimulation by
erythropoietin, hemin (optional) , and a
burst-promoting factor .
BFU-E-2 = an erythroid progenitor cell, of greater
maturity than BFU-E-1, which is capable
of producing a colony of erythroid
progeny cells in semi-solid medium upon
stimulation by erythropoietin and by
hemin (optional) .
CFU = colony-forming unit. A cell which is
capable of producing a colony of progeny
cells in semi-solid medium.
CFU-GEMM = colony-forming unit-granulocyte ,
erythrocyte , monocyte/macrophage ,
megakaryocyte. A multipotent ial
hematopoietic progenitor cell which is
capable of producing a colony composed
35
-18-
of granulocyte, erythrocyte, monocyte/
macrophage, and megakaryocyte progeny,
in semi-solid medium.
CFU-GM = colony-forming unit-granulocyte,
5
macrophage. An hematopoietic progenitor
cell which is capable of producing a
colony composed of granulocyte and
macrophage progeny in semi-solid medium.
10
CFU-S = colony forming unxt-spleen. A
multipotential stem cell with self-
renewal capacity, which, upon
inoculation into lethally-irradiated
mice, is capable of producing a colony
(nodule) on the spleen (s) .
15
CPD = citrate-phosphate-dextrose
CSF = colony stimulating factor
20
DMSO = dimethyl sulfoxide
25
30
DNase = deoxyribonuclease
DPBS = phosphate buffered saline without
magnesium or calcium
FCS = fetal calf serum
heterologous
gene = a gene which is not present, or not
functionally expressed, in the
designated host cell.
35
• - •
-19-
IMDM
= Iscove's Modified Dulbecco's Medium
LD100/30 days =
the minimum or near-minimal Lethal
Dosage causing 100% mortality within a
30-day post-irradiation period
10
PHALCM
PWMSCM
medium conditioned by
phytohemagglutinin-stimulated leukocytes
from patients with hemochromatosis
pokeweed mitogen spleen cell conditioned
medium
15
S-cell
SLE
= stem cell
= systemic lupus erythematosus
HTdr
= tritiated thymidine
20
25
30
35
TLI
= total lymphoid irradiation
4 . DESCRIPTION OF THE FIGURES
Figure 1 presents data for neonatal blood volumes
obtained in one series of collections from individual births.
The volume (ml) of blood collected is shown along the X-axis,
with infant weight (kg) along the Y-axis. Open circles
represent births by Caesarian section; closed circles
represent vaginal births.
Figure 2 presents the data from neonatal blood volumes
obtained in a second series of collections from individual
births. The volume (ml) of blood collected is shown along
the X-axis, with the infant weight (kg) along the Y-axis.
Closed circles represent vaginal births, with collection by
gravity drainage from the umbilical cord. Open circles
represent births by Caesarian section, with collection by
gravity drainage from the umbilical cord. Closed triangles
-20-
represent vaginal births, with collection from the delivered
placenta. Open triangles represent births by Caesarian
section, with collection from the delivered placenta.
Figures 3A and 3B are diagrammatic representations of
the composition of centrifuge tubes at different steps in a
Ficoll-Hypaque density separation, as described in Section
6.3.1, which can be employed to obtain low density cells that
are enriched in hematopoietic stem and progenitor cells. The
cord blood cell suspension is layered on Ficoll-Hypaque
before centrif ugation (Fig. 3 A) . After centrifugation, the
low density cells appear as a sharp band between the Ficoll-
Hypaque and the phosphate-buffered saline (Fig. 3B) .
Figure 4 is a diagrammatic representation of the
apparatus described in Section 6.4, which can be used for the
cryopreservation of neonatal and fetal hematopoietic stem and
progenitor cells. The cryovials containing the cell
suspensions are placed in a freezing rack which is in turn
placed in a 4°C methanol bath. The methanol bath (in a metal
or glass freezing dish) is in turn placed in a -80°C freezer.
After the cells reach the frozen state, they are transferred
to a long-term storage vessel containing liquid nitrogen.
5. DETAILED DESCRIPTION OF THE INVENTION
The present invention is directed to hematopoietic stem
and progenitor cells of neonatal or fetal blood, that are
cryopreserved, and the therapeutic uses of such stem and
progenitor cells upon thawing.
In particular, the present invention relates to the use
of fetal or neonatal stem cells for hematopoietic reconstitu-
tion. In a preferred embodiment of the invention, the fetal
or neonatal stem cells can be used in autologous hematopoie-
tic reconstitution, i.e. , in the reconstitution of the
hematopoietic system of the same individual from which they
were originally derived. In such an embodiment, the
invention provides substantial advantages over the present
• #
-21-
10
15
20
25
30
use of bone marrow for hematopoietic reconstitution. Present
use of bone marrow transplantation is severely restricted by
the fact that there is virtually never a perfectly matched
(genetically identical) donor, except in cases where an
identical twin it> available or where bone marrow cells of,
for example, a cancer patient in remission are stored in the
viable frozen state in the hope that they will be free of
malignant cells and healthy enough to be returned to the
patient for treatment of any future relapse. Except in such
cases, the inevitable genetic mismatch which results can
entail the serious and sometimes lethal complications of host
versus graft or graft versus host disease. In order to avoid
host rejection of the foreign bone marrow cells (host versus
graft reaction) , the patient must be immunologically
incapacitated- Such immune incapacitation is itself a cause
of serious complications. Furthermore, when and if the
donated bone marrow cells become established, they can attack
the patient (graft versus host disease) , who is recognized as
foreign. Even with closely matched family donors, these
complications of partial mismatching are the cause of
substantial mortality and morbidity directly due to bone
marrow transplantation from a genetically different
individual .
In an embodiment of the invention directed to the use of
neonatal stem and progenitor cells for hematopoietic
reconstitution, there are several main reasons for preferring
the use of such neonatal cells to conventional bone marrow
transplantation. First, no donor is required because the
cells can be obtained from neonatal blood that would
otherwise be discarded. Second, in a preferred autologous
system, i.e. , involving use of 'self* neonatal cells, the
complications arising in conventional bone marrow 1
transplantation from the need for pretransplantation drug-
induced or irradiation-induced immune incapacitation and from
acute and chronic graf t-versus-host disease are all
-22-
eliminated because, in this embodiment, neonatal cells are
returned to their original owner and are therefore totally
compatible- For these reasons, present restrictions on the
use of bone marrow transplantation arising from difficulties
in finding even approximately matched donors, and from
disease and mortality due to unavoidable genetic incompatibi-
lity, do not apply to self-reconstitution with neonatal
cells. Third, regarding the preferred autologous embodiment,
the efficiency of genetically identical (self) cells in bone
marrow transplantation in animals is numerically many times
greater than that of cells from a genetically dissimilar
donor (Balner, H. , 1977, Bone Marrow Transplantation and
Other Treatment after Radiation Injury, Martinus Nijhoff
Medical Division, The Hague) , thus far fewer self cells are
required for successful reconstitution in the preferred
autologous system.
Furthermore, the prospects of success in bone marrow
transplantation decline with age; although it is not clear
whether the age of donor or patient is more important, it is
proper to infer that younger (neonatal) cells are preferable
for hematopoietic reconstitution. Such neonatal or fetal
cells have not been subjected to the "environmental outrage"
that adult cells have undergone. Also, as an example of
novel medical applications which may be feasible with
neonatal cells but not with conventional bone marrow
transplantation, restoration with self cells taken at birth
can be valuable in the treatment of disorders such as
declining immune responsiveness and autoimmunity (immune
reactions against one's own tissues) which occur in increas-
ing frequency with age.
Many of the relative disadvantages discussed supra of
the use of bone marrow cells for hematopoietic
reconstitution, also apply to the use of adult peripheral
blood for such reconstitution, and thus, the use of neonatal
cells for hematopoietic reconstitution according to the
35
-23-
present invention provides distinct advantages over the
employment of adult peripheral blood. It has been implied
that the ability of autologous peripheral adult blood to
reconstitute the hematopoietic system, seen in some cancer
patients, is associated with the Jar greater numbers of
circulating progenitor cells in the peripheral blood produced
after cytoreduction due to intensive chemotherapy and/or
irradiation (the rebound phenomenon) (To, L. B. and Juttner,
C.A., 1987, Annot., Brit. *J. , Haematol, 66:285-288; see also
1987, Brit. J. Haematol. 67:252-253, and references cited
therein) . There are possible detrimental effects, known or
unknown, of prior chemotherapy or irradiation, on the stem
and progenitor cell populations found in these patients.
There are additional reasons for preferring the use of
neonatal cells for hematopoietic reconstitution as provided
by the present invention. Neonatal blood is a preferred
source of cells for hematopoietic reconstitution, since it is
free from viral and microbial agents, known or unknown,
latent or otherwise, that may be encountered in later life,
other than those transmitted from the mother or during labor
and delivery* In addition, in view of the extent to which
the hematopoietic stem cell may possibly share with other
cells the limitation in total number of cell divisions that
it may undergo before senescence, it is proper to assume that
the neonatal hematopoietic stem cell has a self-renewal and
reconstituting capacity that is at least as great, and
perhaps greater, than that of hematopoietic stem cells
obtained at any later time in life.
In adults, stem and progenitor cells are mostly confined
to the bone marrow; very few circulate in the blood. In the
newborn human or animal, however, stem and progenitor cells
circulate in the blood in numbers similar to those found in
adult bone marrow. Doubtless this reflects the great demands
for blood formation of the growing infant. We calculate that
the restorative capacity of neonatal blood contained in the
35
-24-
human umbilical cord and placenta, which are customarily
discarded at birth, equals or exceeds that of the average
donation of an adult's bone marrow. The efficacy of human
neonatal blood cells compared with adult bone marrow cells is
gauged by laboratory assays for stem cell and progenitor
cells. Progenitor cell assays imply that the reconstituting
potential of cells from 50 ml of cord blood (readily obtain-
able) is at least equivalent to the average number of
progenitor cells from adult bone marrow that is used in
autologous hematopoietic reconstitution (see Section 6.8,
infra). 'S-cells', representing probably the earliest
developmental form of the stem cell, are demonstrable in
human (cord) blood (Nakahata, T. and Ogawa, M. , 1982, J.
Clin, Invest. 70:1324-1328). Thus, the cells of neonatal
blood can be judged an effective clinical substitute for
adult bone marrow.
In laboratory animals, the efficacy of neonatal cells
can be tested directly. Accordingly we have shown that
circulating neonatal cells, in numbers lower than are
contained in the cord and placenta, will completely and
permanently repopulate the entire blood-forming and immune
systems of a lethally irradiated adult animal, promoting
complete recovery and return to normal health (see Section
6. 11, infra ) .
The method of the invention may be divided into the
following stages solely for the purpose of description:
(a) isolation of fetal or neonatal hematopoietic stem and
progenitor cells; (b) inspection and testing of fetal or
neonatal blood; (c) enrichment for hematopoietic stem and
progenitor cells; (d) cryopreservat ion ; (e) recovery of stem
and progenitor cells from the frozen state; (f) examination
of cells recovered for clinical therapy; and (g) therapeutic
uses in reconstitution of the hematopoietic system.
Since both fetal and neonatal hematopoietic cells are
envisioned for use in the present invention, descriptions and
35
-25-
10
15
20
25
30
35
embodiments of the invention herein described for neonatal
cells are meant to apply equally to fetal cells, unless
clearly otherwise indicated or apparent.
5.1. ISOLATION OF FETAL OR NEONATAL
HEMATOPOIETIC STEM AND PROGENITOR CELLS
Fetal or neonatal blood are sources of the hematopoietic
stem and progenitor cells of the present invention.
Fetal blood can be obtained by any method known in the
art. For example, fetal blood can be taken from the fetal
circulation at the placental root with the use of a needle
guided by ultrasound (Daffos, F. , et al., 1985, Am. J.
Obstet. Gynecol. 153:655-660; Daffos, F. , et al., 1983, Am.
J. Obstet. Gynecol. 146:985), by placentocentesis (Valenti,
C, 1973, Am. J. Obstet. Gynecol. 115:851; Cao, A., et al.,
1982, J. Med. Genet. 19:81), by fetoscopy (Rodeck, C.H. ,
1984, in Prenatal Diagnosis, Rodeck, C.H. and Nicolaides,
K.H., eds., Royal College of Obstetricians and Gynaecol-
ogists, London), etc.
In a preferred embodiment of the invention, neonatal
hematopoietic stem and progenitor cells can be obtained from
umbilical cord blood and/or placental blood. The use of cord
or placental blood as a source of cells to repopulate the
hematopoietic system provides numerous advantages. Cord
blood can be obtained easily and without trauma to the donor.
In contrast, at present, the collection of bone marrow cells
for transplantation is a traumatic experience which is costly
in terms of time and money spent for hospitalization. Cord
blood cells can be used for autologous transplantation, when
and if needed, and the usual hematological and immunological
problems associated with the use of allogeneic cells, matched
only partially at the major histocompatibility complex or
matched fully at the major, but only partially at the minor
complexes, are alleviated.
Collections should be made under sterile conditions.
Immediately upon collection, the neonatal or fetal blood
-26-
10
15
20
25
30
should be mixed with an anticoagulent. Such an anti-
coagulent can be any known in the art, including but not
limited to CPD (citrate-phosphate-dextrose) , ACD (acid
citrate-dextrose), Alsever's solution (Alsever, J.B. and
Ainslie, R.B., 1941, N . Y . St, J. Med, 41:126)~, De Gowin'i-
Solution (De Gowin, E.L., et al., 1940, J- Am. Med, Ass,
114:850), Edglugate-Mg (Smith, W.W., et al., 1959, J • Thorac.
Cardiovasc. Surg, 38:573), Rous-Turner Solution (Rous, P.
and Turner, J.R,, 1916, J. Exp. Med. 23:219), other glucose
mixtures, heparin, ethyl biscoumacetate, etc. (See Hurn,
B.A.L., 1968, Storage of Blood, Academic Press, New York, pp.
26-160) . In a preferred embodiment, ACD can be used.
5.1.1. COLLECTION OF NEONATAL BLOOD
The object of this aspect of the invention is to obtain
a neonatal blood collection of adequate volume that is free
of contamination. Since umbilical cord blood is a rich
source of stem and progenitor cells (see Section 6.6, infra ;
Nakahata, T. and Ogawa, M. , 1982, J. Clin. Invest. 70:1324-
1328; Prindull, G. , et al , , 1978, Acta. Paediatr. Scand.
67:413-416; Tchernia, G. , et al., 1981, J. Lab. Clin. Med.
97 (3) : 322-331) , the preferred source for neonatal blood is
the umbilical cord and placenta. The neonatal blood can
preferably be obtained by direct drainage from the cord
and/or by needle aspiration from the delivered placenta at
the root and at distended veins.
In a preferred embodiment, volumes of 50 ml or more of
neonatal blood are obtained (see Section 6.1, infra).
Practical experience indicates that volumes of 50 ml or
more are easily collected without additional measures in 80%
of term births, and that collections of more than 40 ml are
obtainable more than 90% of the time. Lower volumes may also
be acceptable, and indicated under some circumstances (see
-27-
10
15
20
25
30
Sections 5.1.1.2.3-1 and 5.1.1.2.3.2, infra ) .
The following information suggests that as little as 50
ml of cord blood contains enough of the appropriate cells to
repopulate the hematopoietic system of an adult, and it is
possible that even less cord blood would have the same
effect:
1. In a small sampling of cases for autologous
marrow transplantation (Spitzer, G. , et al M 1980, Blood
55:317-323), rapid repopulation of hematopoiesis in patients
with acute leukemia was associated with as few as 0.24
million granulocyte-macrophage progenitor cells (CFU-GM) .
2. In human cord blood, there are approximately
50-200 CFU-GM per 100,000 low density cells and at least 5
million low density cord blood cells per milliliter. Thus 50
milliliters of cord blood would contain in the range of 0.1
to greater than 0.5 million CFU-GM (see also Section 6.8,
infra) . The upper value agrees closely with estimations from
the number of CFU-GM in 12.5 to 19 day old fetal blood
(Lynch, D.C., et al., 1982, Blood 59:976-979).
3. Importantly, stem and progenitor cells in cord
blood appear to have a greater proliferative capacity in
culture dishes than those in adult bone marrow (Salahuddin,
S.Z., et al., 1981, Blood 58:931-938; Cappellini, M.D., et
al., 1984, Brit. J. Haematol. 57:61-70).
Significant to the use of cord blood as a source of stem
cells, is that the assay for S-cells has been adapted for the
growth of human cord blood (Nakahata, T. and Ogawa, M. , 1982,
J. Clin. Invest. 70:324-1328). All the known progenitor
cells are present in cord blood in high numbers and this
includes those progenitors for multilineages , granulocytes,
macrophages, erythrocytes, mast cells, and basophils ( id . ;
Fauser, A. A. and Messner, H.A. , 1978, Blood 52:1243-1248;
Koizumi, S., et al., 1982, Blood 60:1046-1049; Prindull, G.,
et al., 1978, Acta Paediatr. Scand. 67:413-416).
35
10
15
20
25
30
-28-
Furthermore, hematopoietic stem and progenitor cells can
potentially be multiplied in culture, before or after
cryopreservation, (see Sections 5.1,3-2, 5.3.2, infra), thus
expanding the number of stem cells available for therapy.
5,1-1.2. PREFERRED ASPECTS
The following subsections provide detailed descriptions
of preferred particular embodiments of the invention, and are
intended for descriptive purposes only, in no way limiting
the scope of the invention.
5.1.1-2.1. COLLECTION KIT
In a preferred aspect, a collection kit, packaged in a
sterile container, can be used. In one particular
embodiment, the collection kit can consist of:
(i) a wide-mouth, graduated, collection container,
with anticoagulant, into which the cut end of the cord may be
placed for collection by gravity drainage. A small funnel
can be provided for use if needed.
(ii) (optional) a plastic, flexible, sealed
collection bag, similar to a donation bag, which has ports
for injection of the collected blood, and contains anticoagu-
lant.
(iii) an identification label, which identifies
the infant source of the sample and time of collection.
For multiple births, separate collections, each
performed with a separate kit, are preferred.
Sterilization of the containers can occur by any
technique known in the art, including but not limited to
beta-irradiation, autoclaving of suitable materials in a
steam sterilizer, etc. For example, in a preferred
embodiment, sterilization by beta-irradiation can be carried
out by exposure to 2.5 megarads from a tungsten source (see
Section 6.1, infra) -
35
-29-
The collection kit may be placed in the surgical field
in advance of a delivery, to afford ready availability*
5.1.1.2.2.
VAGINAL DELIVERY OF THE TERM INFANT
Vaginal delivery of the normal infant at term, spontane-
ously, by forceps, or as a breech delivery, should allow an
ample collection of cord blood. After clamping the cord, the
volume of fetal blood remaining in the cord and attached
placenta has been estimated at 4 5 ml/kg infant body weight,
or approximately 145 ml for a 7 lb (3.2 kg) baby (Hellman,
L.M. , et al., 1971, Williams Obstetrics, 14th Ed., Appleton-
Century-Crofts, New York, p. 216) .
Following delivery of the infant, by any method, with or
without anesthesia, the infant is held in the plane of the
vagina, and the cord is doubly cross-clamped and cut
approximately three inches (7-8 cm) from the umbilicus. The
infant is removed.
Maintaining usual sterile precautions, the cord is then
transected just above the crushed portion in the clamp, and
the resulting flow of fetal blood from umbilical vessels is
caught in the container provided- An adequate collection can
usually be accomplished without milking the cord, and is
complete in approximately two minutes, before placental
separation has occurred. Care should be taken to avoid
contamination by maternal blood, urine, or other fluids in
the delivery field. Blood in the container is then
transferred to the bag provided for transport to the storage
facility or, alternatively, the original container, if
equipped with a tight screw cap, can itself be sent to the
storage facility without transfer of its contents.
If, following infant delivery, events make collection at
that time undesirable, collection can be done after delivery
of the placenta (see Section 5.1.1.2.3.6, infra). If
maternal infection is suspected, such a placental collection
may be preferable. Collection can also be carried out by
35
-30-
aspiration from the delivered placenta, in addition to
gravity drainage.
In a most preferred embodiment, immediate cord clamping
after delivery is carried out, in order to achieve collection
of the greatest possible volume of cord blood. Studies have
shown that the relative distribution of blood between the
infant and placental circuits gradually shifts to the
infant's blood circuits with increasing delay in cord
clamping after delivery (Yao, A.C., et al., October 25, 1969,
Lancet: 871-873) .
5.1.1.2.3. OTHER CIRCUMSTANCES OF BIRTH AND DELIVERY
5.1.1.2. 3.1. PREMATURE BIRTH
15
The cord blood of premature infants may contain an even
greater proportion of stem and progenitor cells than full-
term cord blood. Consequently, smaller volumes of cord blood
from premature infant delivery may give as good a yield of
stem and progenitor cells. (The use of stem and progenitor
20
cell assays as described in Sections 5.4.2 and 6.6 can
determine the yield) * Thus, in general, cord blood collec-
tion should be carried out if premature infant survival is
anticipated, even though the volume of blood collected may be
less than usual. Collection procedures should be the same as
25
for term births.
5.1.1.2.3.2. MULTIPLE BIRTHS
Cord blood collections undertaken at the time of
multiple births involve additional procedural considerations:
30
(i) Multiple births are often premature, and
volumes of cord blood will be correspondingly smaller.
Collections should be made nevertheless, so that the decision
to preserve for storage can be made later.
10
15
20
25
30
35
-31-
(ii) When births of two or more infants occur,
where use of the cord collection is envisioned for later
sel f -reconst itut ion , it is essential that each cord
collection be identified with the proper infant. In cases of
..ioubtful zygosity, blood typing can be done on cord blood and.
postnatal samples .
(iii) The timing of twin cord blood collection
can be at the discretion of the obstetrician (after delivery
of one twin; or after delivery of both) .
(iv) A careful description of the placental
relationships should be made (single or double amnions;
single, double or fused chorions) .
5. -1. 1.2.3.3. CAESARIAN DELIVERY
Cord blood collections at caesarean section can be
carried out with the same kit, and with the same procedure,
as vaginal delivery. The cut end of the cord is lowered to
promote gravity drainage.
At caesarean section, it is strongly preferred that the
cord blood collection be made after delivery of the infant,
and before placental separation. However, this may not be
desirable in some instances, such as where there is brisk
hemorrhage, the need to incise or separate an anteriorly
implanted placenta, or preoccupation of personnel with other
events in the operating field. Thus, in these and similar
cases, the placenta can be removed, and cord blood collected
from it later.
5.1.1.2.3.4. COMPLICATED DELIVERY
Complications of delivery arising from the condition of
the mother or the infant, or both, may require the immediate
and urgent attention of the obstetrician and his assistants.
Under these circumstances, the delivered placenta can be
placed to one side, and collection carried out as soon as
feasible.
-32-
5.1.1.2.3.5.
ABNORMAL PLACENTA
For successful cord blood collection, it is preferred
that the placenta be intact, or nearly so. Cases of marginal
or partial separation can still offer an opportunity for
collection, although it may have to be carried out after
delivery of the placenta, if clinical circumstances indicate
a need for prompt removal. Collections will be disfavored
for use if a rupture of fetal circulation has occurred.
Samples can be tested later for contamination by maternal
blood (see Section 5.1.2, infra). Accurate description of
the placental abnormality is preferred.
5.1.1.2.3.6. COLLECTION FROM THE DELIVERED PLACENTA
When rapid delivery of the placenta occurs or becomes
necessary, and cord blood collection cannot be accomplished
prior to placental separation, a sample of sufficient volume
can still be obtained after delivery. The placenta and
attached cord, still clamped, are placed to one side, but
still within the sterile field. Collection is by the same
technique described supra in section 5.1.1.2.2. It is
preferred, however, that collection be completed within five
minutes of delivery/ while maintaining sterile procedures.
Cord blood collection prior to placental separation is
preferred over collection from the delivered placenta for the
following reasons: In a collection from delivered placenta,
(i) collection volumes are generally less; (ii) some degree
of clotting in the placental circulation may restrict
recovery, and (iii) the likelihood of contamination, by
maternal blood or other agents, is increased. Therefore, the
determination of suitability of the sample collected from a
delivered placenta is especially important.
5.1.1.2.3.7. MEDICAL CONDITIONS OF THE MOTHER
Given the general prohibition against maternal use of
drugs which would adversely affect the fetus, it is unlikely
35
-33-
that maternal therapy or medical status in the general sense
would adversely affect stem cell retrieval from cord blood
collection of a normal infant. In a preferred embodiment,
however, specific information should be obtained in regard to
drug abuse, vira. diseases capable of vertical transmission,
and the influence of acute maternal illness at the time of
delivery, since it is possible that these may affect stem
cell retrieval from cord blood.
Despite elaborate plans, delivery may occur inoppor-
tunely, sometimes prematurely, and without the immediate
services of a physician. Under these circumstances, the
following procedures are preferred: (i) cord blood
collection should be attempted with the standard kit,
described supra ; (ii) the placenta, if delivered on an
unsterile field, should simply be kept as clean as possible,
left with the cord clamped, and collection attempted within 5
minutes; (iii) the cord should be wiped with a cleansing
agent ( e.g. Betadine) , and transected above the clamp, to
make the collection; and (iv) circumstances of the delivery
should be described with the specimen.
In a preferred embodiment, the data listed in Table I,
infra , are obtained at the time of collection in order to
ensure the accurate identification and evaluation of the
collected blood.
5.1.1.2.3.8.
UNPLANNED DELIVERY
10
5.1.1.2.4.
RECORDATION OF DATA
30
35
-34-
TABLE I
DATA TO BE RECORDED AT THE
TIME OF NEONATAL BLOOD COLLECTION
5 Date and time ot delivery
Full name and address of mother
Hospital identification
Sex of infant
Weight of infant
10 Birth order (for multiple pregnancies)
Gestational age
Pregnancy complications
Intrapartum complications
Type of delivery
15 Placental collection (amount of blood collected)
Placental description and weight
Condition of infant
20 5.1.2. INSPECTION AND TESTING OF NEONATAL BLOOD
In a preferred embodiment, the neonatal blood sample is
inspected and tested to ensure its suitability. Appropriate
inspections and tests include but are not limited to the
procedures described infra.
25 If the blood collection sample is to be shipped to a
processing plant, the blood container and its contents should
be inspected for defects such as inadequate closure and
leakage. As an option, the collection kit may include a
suitably positioned reusable maximum-minimum mercury
3q thermometer to register the range of temperature change
during shipment. Clots, opacity of the plasma and visible
hemolysis are indications of bacterial contamination or other
consequences of faulty handling. Time elapsed since
collection can be noted.
35
n # - •
-35-
The following tests on the collected neonatal blood
sample can be performed either routinely, or where clinically
indicated:
(i) Bacterial culture: To ensure the absence of
microbial contamination, establis: led assays can be performed,
such as routine hospital cultures for bacteria under aerobic
and anaerobic conditions.
(ii) Diagnostic screening for pathogenic microorganisms:
To ensure the absence of specific pathogenic microorganisms,
various diagnostic tests can be employed. Diagnostic
screening for any of the numerous pathogens transmissible
through blood can be done by standard procedures. As one
example, the collected blood sample can be subjected to
diagnostic screening for the presence of Human
Immunodeficiency Virus (HIV) , the causative agent of Acquired
Immune Deficiency Syndrome (AIDS) (Gallo et al. , 1984,
Science 224:500-503; Barre-Sinoussi, F. , et al., 1983,
Science 220:868; Levy, J. A. , et al., 1984, Science 225:840).
Any of numerous assay systems can be used, based on the
detection of virions, viral-encoded proteins, HIV-specific
nucleic acids, antibodies to HIV proteins, etc.
(iii) Confirmation of neonatal origin of the blood:
Contamination with maternal blood, not necessarily a
contraindication to storage and clinical utility, may be
suspected from the obstetrical history. Presence of maternal
cells, and of adult blood generally, can be revealed by
various tests, including but not limited to I typing (Wiener,
A.S., et al,, 1965, Am. J. Phys. Anthropol. 23(4): 389-396);
analysis on a Coulter Channelyzer, which detects size
differences between neonatal and maternal blood cells
(Daffos, F., et al., 1985, Am. J. Obstet. Gynecol. 153:655-
660) ; staining procedures for hemoglobin such as the
Kleinhauer-Betke technique (Betke, K. , 1968, Bibl.
Haematologica 29:1085) and others (Clayton, E.M., et al.,
1970, Obstetrics and Gynecology 35 ( 4 ) : 642-64 5 ) , which detect
35
-36-
differences in the types of hemoglobin contained in red blood
cells before birth versus in later life; etc.
In a preferred embodiment, I typing can be done by
established methods, such as agglutination with anti-i and
anti-I antibodies. Erythrocytes of neonates are i strong, t
weak; by 18 months of age, erythrocytes are I strong; i weak
(Marsh, W.L., 1961, Brit- J. Haemat. 7:200). Thus, the
degree of reaction with anti-i or anti-I antibodies is a
measure of the proportion of neonatal blood and red cells in
a mixture of neonatal and adult blood. The corresponding
contamination with maternal stem and progenitor cells would
be far less than the total maternal cell contamination since
the stem and progenitor cells are rare in adult blood.
(Scarcity of stem and progenitor cells in colony assays (see
Sections 5.4.2 and 6.6, infra ) is another distinction between
neonatal and adult blood. )
In a preferred embodiment of the invention, whole
neonatal blood, as collected, can be cryogenically frozen,
thus minimizing cell losses which can be incurred during cell
processing protocols. However, cell separation procedures
and expansion of stem and progenitor cells in in vitro
cultures remain options. Such procedures may be useful,
e.g. , in reducing the volume of sample to be frozen, and
increasing cell count, respectively. The procedures
described infra in Sections 5.1.3.1 and 5.1.3.2 should be
carefully screened before use, in order to ensure that
hematopoietic stem and progenitor cell loss in processing
does not endanger the therapeutic efficacy of a collected
10
5.1.3.
OPTIONAL PROCEDURES
30
blood sample in hematopoietic reconstitution.
35
-37-
5.1.3.1.
ENRICHMENT FOR HEMATOPOIETIC STEM AND
PROGENITOR CELLS: CELL SEPARATION PROCEDURES
After receiving cord blood or bone marrow samples in
anticoagulant ( e.g. , ACD) , the cells can be subjected to
physical and/or immunological cell separation procedures.
5 - :
Such procedures enrich for the hematopoietic stem and
progenitor cells so that fewer total cells have to be stored
and transplanted. However, if cell separation is desired,
care should be taken to ensure sufficient recovery of the
hematopoietic stem and progenitor cells.
1 ^ Various procedures are known in the art and can be used
to enrich for the stem and progenitor cells of the present
invention. These include but are not limited to equilibrium
density centrifugation, velocity sedimentation at unit
gravity, immune rosetting and immune adherence, counter flow
15 centrifugal elutriation, T lymphocyte depletion, and
fluorescence-activated cell sorting, alone or in combination.
Recently, procedures have been reported for the isolation of
very highly enriched populations of stem/progenitor cells.
Murine CFU-S have been purified by several groups using
20 slightly different procedures (Visser, J.W.M., et al., 1984,
J. Exp. Med. 59:1576; Nijhof, W. , et al., 1984, Exp. Cell
Res. 155:583; Bauman, J.G.J. , et al., 1986, J. Cell. Physiol.
128:133; Lord, B.I. and Spooncer, E., 1986, Lymphokine Res.
5:59). Studies using human (Emerson, S.G., et al., 1985, J.
25 Clin. Invest. 76:1286) or murine (Nicola, N.A. , et al., 1981,
Blood 58:376) fetal liver cells have yielded highly enriched
progenitor cells with up to 90% of them being colony forming
cells for multi-, erythroid-, and granulocyte-macrophage
lineages. CFU-E have also been very highly enriched (Nijhof,
30 w., et al., 1983, J. Cell Biol. 96:386). Purification of
adult mouse marrow CFU-GM with cloning efficiencies of up to
99% in semi-solid medium has been accomplished by
pretreatment of mice three days prior to sacrifice with
cyclophosphamide, density separation of cells on Ficoll-
35
15
-38-
Hypaque, and counterflow centrifugal elutriation (Williams,
D.E., et al., 1987, Exp. Hematol. 15:243). The resulting
fraction of cells contained no detectable CFU-GEMM, BFU-E or
CFU-MK, but up to 10% of the cells formed CFU-S measured at
day 12, These procedures, or modifications thereof, can I a
5
used, and are within the scope of the present invention.
Human stem and progenitor cells are present in the non-
adherent, low density, T-lymphocyte-depleted fraction of bone
marrow, spleen, and (adult and cord) blood cells. In a
specific embodiment, low density (density less than 1.077
10 3
gm/cm ) cells can be separated by use of Fxcoll-Hypaque
(Pharmacia Fine Chemicals, Piscataway, NJ) (see Section
6.3.1, infra ) or Percol (Broxmeyer, H.E., 1982, J. Clin.
Invest. 69:632-642). In this procedure, the mature cells of
the granulocytic series, which are not needed for
transplantation, are removed in the dense fraction which goes
to the bottom of the tube. An adherence/nonadherence
separation protocol can also be used for enrichment of
hematopoietic stem and progenitors; protocols which can be
used are described in Section 6.3.2, infra , and in Broxmeyer,
H.E., et al., 1984, J. Clin. Invest. 73:939-953, which is
incorporated by reference herein.
If desired, autologous plasma can be removed for use in
the freezing process. In particular, the blood or marrow
samples can be allowed to settle at unit gravity in a test
tube. The setting process can be hastened by addition of
sterile-pyrogen-free Dextran Sulphate. After approximately
15 minutes, the upper layer containing the nucleated cells in
plasma can be removed and centrifuged ( e.g. , 200-400 X g) .
The nucleated cells pellet to the bottom of the tube and the
plasma is removed and stored in a tube at 4°C. The nucleated
cells are washed, counted and, if desired, further separated
( e.g, , by use of a density 'cut* procedure with Ficoll-
Hypaque or Percol) .
In order to enrich hematopoietic stem and progenitor
35
20
25
30
i>7
-39-
cells, it is also possible to use cell separation procedures
that entail immunological recognition of cells. Stem and
progenitor cells can be isolated by positive or negative
selection using antibodies that recognize antigenic
determinants on the surface of cells. One means is to
separate the cells by using monoclonal antibodies which
recognize cell surface determinants on these cells, in
conjunction with separation procedures such as fluorescence-
activated cell sorting or panning (Broxmeyer, H.E., et al.,
1984, J* Clin. Invest. 73:939-953). At present, there are no
known antigenic determinants that are absolutely specific for
human hematopoietic stem and progenitor cells. However,
these cells do contain antigenic determinants that are not
present on all other cells, which can be used in antibody
selection protocols for enrichment purposes; such antigens
include but are not limited to those described infra .
Within the human system, several antigens have been
found on stem/progenitor cells. The first antigenic system
studied intensively was that of the MHC class II antigens,
especially HLA-DR. This has been found on CFU-GEMM, BFU-E,
and CFU-GM (Lu, L. , et al., 198 3, Blood 61:250; Winchester,
R.J., et al., 1977, Proc. Natl. Acad. Sci. U.S.A. 74:4012;
Busch, F,W., et al., 1987, Blut 54:179). Several investigat-
ors have suggested that HLA-DR are not found, or are present
at a low density on cells earlier than CFU-GEMM (Moore,
M.A.S., et al., 1980, Blood 55:682; Keating, A., et al.,
1984, Blood 64:1159) but others have not agreed ( e.g. ,
Falkenberg, J.H.F., et al., 1985, J. Exp. Med. 162:1359).
This discrepancy may be due to the existence of specific
subsets of early progenitors. In fact, the expression of
HLA-DR is higher during the S-phase of the cell cycle of
hematopoietic progenitor cells (Broxmeyer, H.E., 1982, J.
Clin. Invest. 69:632; Cannistra, S.A., et al., 1985, Blood
65:414). Day 14 CFU-GM express higher levels of HLA-DR than
day 7 CFU-GM, and among day 7 CFU-GM, monocyte progenitors
35
-40-
express more HLA-DR than do the granulocyte progenitors
(Griffin, J.D., et al., 1985, Blood 66:788)- Expression of
HLA-DR decreases and is lost during early myeloid precursor
cell states and it has been suggested that HLA-DR antigens
might play a role in myeloid development (Winchester , R.J . ,
et al., 1977, supra ) .
Groups of antibodies have been used to distinguish
different progenitors of the granulocyte-macrophage lineage
(Ferrero, D. , et al., 1983, Proc. Natl, Acad. Sci. U.S.A.
80:4114). Type 1 CFU-GM contribute all of the peripheral
blood CFU-GM, as well as a small number of bone marrow CFU-
GM. They express surface antigens recognized by S3-13 and
S17-25 antibodies, but not by R1B19 and WGHS-29-1 antibodies.
Type 2 CFU-GM are present only in the marrow and react with
S3-13, R1B19, and WGHS-29-1. Culture of type 1 CFU-GM in
liquid culture generates type 2 CFU-GM. These antibodies
have also been used to characterize CFU-GM from patients with
chronic myeloproliferative disorders (Robak, T. , et al.,
1985, Leukemia Res. 9:1023; Ferrero, D. , et al., 1986, Cancer
Res. 46:975) .
Other antigens on human stem/progenitor cells include
those reactive with the MylO (Leary, A.G., et al., 1987,
Blood 69:953; Strauss, L.C., et al . , 1986, Exp. Hematol.
14:879), 3C5 (Katz, F.E., et al . , 1985, Leukemia Res. 9:191;
Katz, F.E., et al., 1986, Leukemia Res. 10:961), RFB-1
(Bodger, M.P., et al., 1983, Blood 61:1006), 12-8 (Andrews,
R.G., et al., 1986, Blood 67:842), and L4F3 (Andrews, R.G. ,
et al., 1986, Blood 68:1030) antibodies. The antigen
recognized by L4F3 is on CFU-GM, CFU-MK, BFU-E, and CFU-GEMM ,
but is apparently absent from cells which generate these
progenitors in suspension culture ( id. ) . L4F3 reacts with
most blast cells from patients with acute myelogenous
leukemia, and treatment of cells from such patients with L4F3
has allowed the growth of normal progenitor cells in vitro
(Bernstein, I.D., et al., 1987, J. Clin. Invest. 79:1153).
35
-41-
The antigen recognized by another antibody, Myll, is
expressed on CFU-GM, but not on BFU-E or CFU-GEMM (Strauss,
L.C., et al. , 1986, Exp. Hematol . 14:935). Receptors for
various lectins are also expressed on stem/progenitors
(Nicola, N.A., et al., 1980, J . Cell Physiol. 103:217;
Reisner, Y. , et al., 1982, Blood 59:360; Reisner, Y. , et al.,
1978, Proc. Natl. Acad. Sci. U.S.A. 75:2933; Aizawa, S., and
Tavassoli, M. , 1986, Int. J. Cell Cloning 4:464).
Some success in enriching adult human bone marrow
progenitor cells has been reported based on the use of
monoclonal antibodies and cell sorting. In some studies,
cells have been sorted only on positive versus negative
populations (Katz, F.E., et al., 1986, Leukemia Res. 10:961).
Recently, My 10 and HLA-DR antibodies were used in association
with two color sorting to obtain highly enriched progenitor
cell populations from human marrow (Lu, L. , et al., 1987, J.
Immunol. 139(6) :1823-1829) .
In specific embodiments, antibodies which are currently
available and can be used in enrichment protocols include
My-10, 3C5, or RFB-1. These antibodies can be used alone or
in combination with procedures such as "panning" (Broxmeyer,
H.E., et al., 1983, J. Clin. Invest. 73:939-953) or
fluorescence activated cell-sorting (FACS) (Williams, D.E.,
et al., 1985, J. Immunol. 135:1004; Lu, L. , et al., 1986,
Blood 68 (1) : 126-133) to isolate those cells containing
surface determinants recognized by the monoclonal antibodies.
In another embodiment, enrichment, if desired, can
proceed by the use of monoclonal antibodies to major
histocompatibility (MHC) class II antigens (especially HLA-
DR) and to MylO (Lu, L. , et al., 1987, J. Immunol. 139(6):
1823-1829.
T lymphocyte depletion can also be used to enrich for
hematopoietic stem or progenitor cells. In this procedure, T
lymphocytes are selectively removed from the cell population
by pretreating cells with a monoclonal antibody ( ies) , that
35
-42-
10
15
20
25
30
recognize a T cell antigen, plus complement:. Such a
procedure has been described previously (Broxmeyer, H . E . , et
al., 1984, J. Clin. Invest. 73:939-953).
Another method that can be used is that of separating
the stem and progenitor cells by means of selective agglu-
tination using a lectin such as soybean (Reisner, Y. , et al.,
1980, Proc. Natl. Acad. Sci. U.S.A. 77:1164). This procedure
can be a viable alternative for separation and enrichment of
stem and progenitor cells without removal of possibly
necessary accessory cells (Reisner, Y. , et al., 1983, Blood
61(2) : 341-348; Reisner, Y. , et al . , 1982, Blood 59(2) :360-
363) .
Theoretically, only one early stem cell is needed for
repopulation of the entire hematopoietic system. There is
laboratory evidence that under ideal conditions and when the
microenvironment nurturing the stem and progenitor cells in
the recipient animal is not affected, a single stem cell can
entirely repopulate the defective hematopoietic system of a
mouse and rescue it from the lethal complications of anemia
(Boggs, D.R. , et al . , 1982, J. Clin. Invest. 70:242-253).
Doubtless, under clinical conditions in man it would
generally require more than a single stem cell to rescue the
hematopoietic system. Moreover, the presence of accessory or
helper cells (non-stem/progenitor cells that influence the
growth of stem/progenitor cells) , in addition to stem and
progenitor cells, may be required (Spooncer, F. , et al. ,
1985, Nature (London) 316:62-64), especially if the
microenvironment of the host is injured by treatments such as
irradiation or chemotherapy. Thus, while there are ways to
separate hematopoietic stem and progenitor cells from other
cord blood cells (Leary, A.G. , et al., 1984, J. Clin. Invest.
74:2193-2197) and these and other methods could be used to
isolate and store pure or highly enriched preparations of
these cells for transplantation, caution should be used in
attempts at transplanting patients with purified preparations
-43-
of stem and progenitor cells,
5.1,3,2 . IN VITRO CULTURES OF HEMATOPOIETIC
STEM AND PROGENITOR CELLS
An optional procedure (either before or after cryopres- .
5 ervation) is to expand the hematopoietic stem and progenitor
cells ijn vitro . However, care should be taken to ensure that
growth in vitro does not result in the production of differ-
entiated progeny cells at the expense of multipotent stem and
progenitor cells which are therapeutically necessary for
10 hematopoietic reconstitution. Various protocols have been
described for the growth in vitro of cord blood or bone
marrow cells, and it is envisioned that such procedures, or
modifications thereof, may be employed (see Section 6*9
infra; Smith, S, and Broxmeyer, H.E., 1986, Br, J. Haematol,
15 63:29-34; Dexter, T.M, , et al., 1977, J • Cell. Physiol,
91:335; Witlock, C.A, and Witte, O.N,, 1982, Prbc. Natl.
Acad. Sci. U.S.A. 79:3608-3612). Various factors can also be
tested for use in stimulation of proliferation in vitro ,
including but not limited to interleukin-3 (IL.-3) ,
20 granulocyte-macrophage (GM) -colony stimulating factor (CSF) ,
IL-1 (hemopoietin-1) , IL-4 (B cell growth factor) , IL-6,
alone or in combination.
5.2. CRYOPRESERVATION
25 The freezing of cells is ordinarily destructive. On
cooling, water within the cell freezes. Injury then occurs
by osmotic effects on the cell membrane, cell dehydration,
solute concentration, and ice crystal formation. As ice
forms outside the cell, available water is removed from
30 solution and withdrawn from the cell, causing osmotic
dehydration and raised solute concentration which eventually
destroy the cell. (For a discussion, see Mazur, P., .1977,
Cryobiology 14:251-272.)
These injurious effects can be circumvented by (a) use
35
-44-
of a cryoprotective agent, (b) control of the freezing rate,
and (c) storage at a temperature sufficiently low to minimize
degradative reactions .
Cryoprotective agents which can be used include but are
not limited to dimethyl sulfoxide (DMSO) (Lovelock, J.E. and
Bishop, M.W.H., 1959, Nature 183:1394-1395; Ashwood-Smith,
M.J., 1961, Nature 190:1204-1205), glycerol,
polyvinylpyrrolidine (Rinfret, A. P., 1960, Ann. N. Y. Acad.
Sci. 85:576), polyethylene glycol (Sloviter, H.A. and Ravdin,
R.G., 1962, Nature 196:548), albumin, dextran, sucrose,
ethylene glycol, i-erythritol , D-ribitol, D-mannitol (Rowe,
A.W., et al., 1962, Fed. Proc. 21:157), D-sorbitol,
i-inositol, D-lactose, choline chloride (Bender, M.A. , et
al., 1960, J. Appl. Physiol. 15:520), amino acids (Phan The
Tran and Bender, M.A. , 1960, Exp. Cell Res. 20:651),
methanol, acetamide, glycerol monoacetate (Lovelock, J.E.,
1954, Biochem. J. 56:265), and inorganic salts (Phan The Tran
and Bender, M.A. , 1960, Proc. Soc. Exp. Biol. Med. 104:388;
Phan The Tran and Bender, M.A. , 1961, in Radiobiology ,
Proceedings of the Third Australian Conference on
Radiobiology, Ilbery, P.L.T., ed. , Butterworth, London, p.
59) . In a preferred embodiment, DMSO is used, a liquid which
is nontoxic to cells in low concentration. Being a small
molecule, DMSO freely permeates the cell and protects
intracellular organelles by combining with water to modify
its freezability and prevent damage from ice formation.
Addition of plasma ( e.g. , to a concentration of 20-25%) can
augment the protective effect of DMSO. After addition of
DMSO, cells should be kept at 0*C until freezing, since DMSO
concentrations of about 1% are toxic at temperatures above
4 °C.
A controlled slow cooling rate is critical. Different
cryoprotective agents (Rapatz, G., et al., 1968, Cryobiology
5(l):18-25) and different cell types have different optimal
cooling rates ( see e.g. , Rowe, A.W. and Rinfret, A. P., 1962,
35
-45-
10
15
20
25
30
Blood 20:636; Rove, A.W., 1966, Cryobiology 3(1): 12-18;
Lewis, J, P., et al., 1967, Transfusion 7(1): 17-32; and Mazur,
P., 1970, Science 168:939-949 for effects of cooling velocity
on survival of marrow-stem cells and on their transplantation
potential) . Th<_ heat of fusion phase where water turns to
ice should be minimal. The cooling procedure can be carried
out by use of, e.g. , a programmable freezing device or a
methanol bath procedure.
Programmable freezing apparatuses allow determination of
optimal cooling rates and facilitate standard reproducible
cooling. Programmable control led-rate freezers such as
Cryomed or Planar permit tuning of the freezing regimen to
the desired cooling rate curve. For example, for marrow
cells in 10% DMSO and 20% plasma, the optimal rate is 1 to
3°C/minute from 0'C to -80°C. In a preferred embodiment,
this cooling rate can be used for the neonatal cells of the
invention. The container holding the cells must be stable at
cryogenic temperatures and allow for rapid heat transfer for
effective control of both freezing and thawing. Sealed
plastic vials ( e.g. , Nunc, Wheaton cryules) or glass ampules
can be used for multiple small amounts (1-2 ml) , while larger
volumes (100-200 ml) can be frozen in polyolefin bags ( e.g. ,
Delmed) held between metal plates for better heat transfer
during cooling. (Bags of bone marrow cells have been
successfully frozen by placing them in -80 °C freezers which,
fortuitously, gives a cooling rate of approximately
3 *C/minute) .
In an alternative embodiment, the methanol bath method
of cooling can be used. The methanol bath method is well-
suited to routine cryopreservation of multiple small items on
a large scale. The method does not require manual control of
the freezing rate nor a recorder to monitor the rate. In a
preferred aspect, DMSO-treated cells are precooled on ice and
transferred to a tray containing chilled methanol which is
placed, in turn, in a mechanical refrigerator ( e.g. , Harris
-46-
or Revco) at -80 °C Thermocouple measurements of the
methanol bath and the samples indicate the desired cooling
rate of 1 to 3°C/minute. After at least two hours, the
specimens have... reached a temperature of -80°C and can be
placed directly into liquid nitrogen (-196*C) for permanent
storage*
After thorough freezing, cells can be rapidly trans-
ferred to a long-term cryogenic storage vessel . In a
preferred embodiment, samples can be cryogenically stored in
liquid nitrogen (-196*C) or its vapor (-165°C). Such storage
is greatly facilitated by the availability of highly
efficient liquid nitrogen refrigerators, which resemble large
Thermos containers with an extremely low vacuum and internal
super insulation, such that heat leakage and nitrogen losses
are kept to an absolute minimum.
In a particular embodiment, the cryopreservation
procedure described in Section 6*4 infra is envisioned for
use. The sterilized storage cryules preferably have their
caps threaded inside, allowing easy handling without
contamination. Suitable racking systems are commercially
available and can be used for cataloguing, storage, and
retrieval of individual specimens.
Considerations and procedures for the manipulation,
cryopreservation, and long-term storage of hematopoietic stem
cells, particularly from bone marrow or peripheral blood, is
largely applicable to the neonatal and fetal stem cells of
the invention. Such a discussion can be found, for example,
in the following references, incorporated by reference
herein: Gorin, N.C., 1986, Clinics In Haematology 15(1) :19-
48; Bone-Marrow Conservation, Culture and Transplantation,
Proceedings of a Panel, Moscow, July 22-26, 1968,
International Atomic Energy Agency, Vienna, pp. 107-186.
Other methods of cryopreservation of viable cells, or
modifications thereof, are available and envisioned for use
( e.g. , cold metal-mirror techniques; Livesey, S.A. and
35
-47-
Linner, J.G., 1987, Nature 327:255; Linner, J.G. , et al.,
1986, J, Histochem. Cytochem. 34 (9) : 1123-1135 ; see. also U.S.
Patent No. 4,199,02 2 by Senkan et al., U.S. Patent No.
3,753,357 by Schwartz, U.S. Patent No. 4,559,298 by Fahy; and
Section 2.3, supra ) .
5.3. RECOVERING STEM AND PROGENITOR
CELLS FROM THE FROZEN STATE
5.3.1. THAWING
Frozen cells are preferably thawed quickly ( e.g. , in a
10 water bath maintained at 37-41 °C) and chilled immediately
upon thawing. In particular, the vial containing the frozen
cells can be immersed up to its neck in a warm water bath;
gentle rotation will ensure mixing of the cell suspension as
it thaws and increase heat transfer from the warm water to
15 the internal ice mass. As soon as the ice has completely
melted, the vial can be immediately placed in ice (see
Section 6.5, infra ) .
5.3.2. OPTIONAL PROCEDURES
20 in a preferred embodiment of the invention, the neonatal
blood sample as thawed can be infused for hematopoietic
reconstitution. Thus, it is envisioned that whole neonatal
blood, cryopreserved and thawed, can be infused for therapy.
However, several procedures, relating to processing of the
25 thawed cells are available, and can be employed if deemed
desirable. Such procedures are discussed infra .
It may be desirable to treat the cells in order to
prevent cellular clumping upon thawing. To prevent clumping,
various procedures can be used, including but not limited to,
30 the addition before and/or after freezing of DNase (Spitzer,
G., et al., 1980, Cancer 45:3075-3085), low molecular weight
dextran and citrate, hydroxyethyl starch (Stiff, P. J. , et
al., 1983, Cryobiology 20:17-24), etc.
The cryoprotective agent, if toxic in humans, should be
35
10
15
20
25
30
-48-
removed prior to therapeutic use of the thawed neonatal stem
and progenitor cells. In an embodiment employing DMSO as the
cryopreservative, it is preferable to omit this step in order
to avoid cell loss, since DMSO has no serious toxicity.
However, where removal of the cryoprotec :ive agent is
desired, the removal is preferably accomplished upon thawing.
One way in which to remove the cry ©protective agent is
by dilution to an insignificant concentration. This can be
accomplished by addition of medium, followed by, if
necessary, one or more cycles of centrifugation to pellet
cells, removal of the supernatant, and resuspension of the
cells. For example, intracellular DMSO in the thawed cells
can be reduced to a level (less than 1%) that will not
adversely affect the recovered cells. This is preferably
done slowly to minimize potentially damaging osmotic
gradients that occur during DMSO removal (see Section 6,5,
infra . )
After removal of the cryoprotective agent, cell count
( e.g. , by use of a hemocytometer) and viability testing
( e.g. , by trypan blue exclusion; Kuchler, R.J. 1977,
Biochemical Methods in Cell Culture and Virology, Dowden,
Hutchinson & Ross, Stroudsburg, Pa., pp. 18-19; 1964, Methods
in Medical Research, Eisen, H.N., et al., eds., Vol. 10, Year
Book Medical Publishers, Inc., Chicago, pp. 39-47) can be
done to confirm cell survival.
Other procedures which can be used, relating to
processing of the thawed cells, include enrichment for
hematopoietic stem and progenitor cells (see Section 5.1.3.1,
supra ) and expansion by in vitro culture (see Section
5.1.3.2, supra ) . However, in a preferred embodiment, these
steps can be omitted in order to minimize cell loss.
5.4. EXAMINATION OF CELLS RECOVERED
FOR CLINICAL THERAPY
In a preferred, but not required, aspect of the
35
41
10
15
20
25
-49-
invention, thawed cells are tested by standard assays of
viability ( e.g. , trypan blue exclusion) and of microbial
sterility (see Section 5.1.2, supra ) , and tested to confirm
and/or determine their identity relative to the patient, and
for hematopoietic function.
5.4.1. IDENTITY TESTING
Methods for identity testing which can be used include
but are not limited to HLA (the major histocompatibility
complex in man) typing (Bodmer, W. , 1973, in Manual of Tissue
Typing Techniques, Ray, J.G., et al., eds., DHEW Publication
No. (NIH) 74-545, pp* 24-27), and DNA fingerprinting, which
can be used to establish the genetic identity of the cells.
DNA fingerprinting (Jeffreys, A.J., et al., 1985, Nature
314:67-73) exploits the extensive restriction fragment length
polymorphism associated with hypervariable minisatellite
regions of human DNA, to enable identification of the origin
of a DNA sample, specific to each individual (Jeffreys, A.J. ,
et al., 1985, Nature 316:76; Gill, P., et al., 1985, Nature
318:577; Vassart, G. , et al., 1987, Science 235:683), and is
thus preferred for use.
In a specific embodiment of the invention in which the
cells recovered for therapy are to be used in an autologous
system, the cells should match exactly the recipient patient
from whom they originally came.
5.4.2. ASSAYS FOR STEM AND PROGENITOR CELLS
Any of numerous assays for hematopoietic stem or
progenitor cells may be used (see Section 2.1). Examples of
specific assays are described in Section 6.6 and subsections,
30 infra . Modifications of the assays therein described are
also envisioned for use. For example, various factors, alone
or in combination, can be tested for stimulation of colony
formation upon inclusion in the culture mixture (se£
Broxmeyer, H.E., 1986, Int. J. Cell Cloning 4:378-405; Lu, L.
35
-50-
and Broxmeyer, H.E., 1983, Exp. Hematol. 11 (8) : 721-729 ; Lu,
L. and Broxmeyer, H.E., 1985, Exp, Hematol. 13:989-993); such
factors include but are not limited to oxygen tension, E-type
prostaglandins, interleukin-3 (IL-3) , granulocyte-macrophage
(GM) -colony stimulating factor (CSF) , granulocyte (G) -CSF-,
macrophage (M)-CSF (CSF-1) , erythropoietin, IL-1, IL-4 (B
cell growth factor) , hemin (ferric chloride protoporphyrin
IX) , and media conditioned by various cell types. Culture
assay methods may thus be changed to employ more efficient
conditions for colony growth. In addition to in vitro colony
forming assays, a stem cell assay for CFU-S (colony forming
unit-spleen) can be done. In this assay, cells considered to
be multipotential stem cells with self -renewal capacity can
be measured by counting the number of colonies (nodules) on
the spleen (s) of lethally-irradiated mice that have been
inoculated with a composition containing the cells.
In a particular embodiment, low density Ficoll-Hypaque-
3
separated cells (density less than 1,077 gm/cm ), which
include the stem and progenitor cells, are plated, usually
5
0.5-2,0 x 10 per plate, for recognition of S (stem) cells,
and progenitor cells of the CFU-GEMM (multipotent ) and CFU-GM
and BFU-E (more differentiated) categories.
The neonatal hematopoietic stem and progenitor cells of
the present invention can be used therapeutically for
hematopoietic reconstitution, with either syngeneic or
allogeneic hosts. The neonatal cells can be introduced into
a patient for repopulation of the blood and other
hematopoietic organs in the treatment or prevention of
various diseases or disorders, as described infra in Section
5.6. Introduction of the neonatal cells can occur by any
method known in the art, with systemic infusion of cells
being the preferred route.
5.5
HEMATOPOIETIC RECONSTITUTION
35
-51-
In a preferred embodiment of the invention, the neonatal
cells are autologous (self) cells, i.e. , the cells were
originally derived from the host recipient. Such an
embodiment avoids the immunosuppressive regimens ( e.g. ,
irradiation, chemotherapy) which are often necessary in
allogeneic transplants in order to avoid debilitating graft
versus host or host versus graft disease.
10
15
20
25
30
5.6. THERAPEUTIC USES
Reconstitution of the hematopoietic system (or immune
system) with the neonatal stem and progenitor cells of the
present invention can be therapeutically valuable for a large
number of diseases and disorders.
In a preferred embodiment involving the use of
autologous neonatal cells, the infusion of previously
cryopreserved neonatal hematopoietic stem and progenitor
cells for hematopoietic reconstitution at any time after
birth can not only be applied in the treatment of diseases
which are presently known to be curable by allogeneic bone
marrow transplantation, but also offers therapeutic potential
for a number of additional diseases which presently are not
considered likely to benefit from allogeneic marrow
transplantation. This is due to the fact that allogeneic
marrow transplantation (except for the few patients who are
already immunologically incompetent) requires
pretransplantation conditioning of the recipient with
intensive cytoreduction with irradiation or chemotherapy for
the purpose of eliminating the host (recipient) immune system
in order to allow the transplanted marrow cells to engraft.
This pretransplantation cytoreduction in combination with
allogeneic HIA-ident ical marrow transplantation can result in
a number of serious transplantation-induced complications
such as life-threatening infections, long-lasting
immunodeficiencies , and frequently, graf t-versus-host
disease .
35
£2
-52-
Disorders that can be treated by infusion of stem cells
include but are not limited to five broad categories. First
are diseases resulting from a failure or dysfunction of
normal blood cell production and maturation ( i. e. , aplastic
anemia and hypoprol iterative stem cell disorders). The
second group are neoplastic, malignant diseases in the
hematopoietic organs ( e.g. , leukemia and lymphomas) . The
third group of disorders comprises those of patients with a
broad spectrum of malignant solid tumors of non-hematopoietic
origin. Stem cell infusion in these patients serves as a
bone marrow rescue procedure, which is provided to a patient
following otherwise lethal chemotherapy or irradiation of the
malignant tumor. The fourth group of diseases consists of
autoimmune conditions, where the stem cells serve as a source
of replacement of an abnormal immune system. The fifth group
of diseases comprises a number of genetic disorders which can
be corrected by infusion of hematopoietic stem cells,
preferably syngeneic, which prior to transplantation have
undergone gene therapy. Particular diseases and disorders
which can be treated by hematopoietic reconstitution with
neonatal stem and progenitor cells include but are not
limited to those listed in Table II, and described infra .
25
30
35
53
-53-
10
TABLE II
DISEASES OR DISORDERS WHICH CAN BE
TREATED BY HEMATOPOIETIC RECONSTITUTION
WITH NEONATAL STEM AND PROGENITOR CELLS
I. Diseases resulting from a failure or dysfunction of
normal blood cell production and maturation
hyperprolif erative stem cell disorders
aplastic anemia
pancytopenia
agranulocytos is
thrombocytopenia
red cell aplasia
15 Blackf an-Diamond syndrome
due to drugs, radiation, or infection
idiopathic
II. Hematopoietic malignancies
20 acute lymphoblastic (lymphocytic) leukemia
chronic lymphocytic leukemia
acute myelogenous leukemia
chronic myelogenous leukemia
acute malignant myelosclerosis
multiple myeloma
polycythemia vera
agnogenic myelometaplasia
Waldenstrom ' s macroglobul inemia
Hodgk i n ' s 1 ymphoma
30 non-Hodgkins's lymphoma
III. Immunosuppression in patients with malignant, solid
tumors
ma 1 ignan t me 1 anoma
35
-54-
carcinoma of the stomach
ovarian carcinoma
breast carcinoma
small cell lung carcinoma
retinoblastoma
testicular carcinoma
glioblastoma
rhabdomyosarcoma
neuroblastoma
Ewing's sarcoma
lymphoma
IV • Autoimmune diseases
rheumatoid arthritis
diabetes type I
chronic hepatitis
multiple sclerosis
systemic lupus erythematosus
Genetic (congenital) disorders
anemias
familial aplastic
Fanconi ' s syndrome
Bloom's syndrome
pure red cell aplasia (PRCA)
dyskeratosis congenita
Blackf an-Diamond syndrome
congenital dyserythropoietic syndromes I-IV
Chwachmann-Diamond syndrome
dihydrofolate reductase deficiencies
formamino transferase deficiency
Lesch-Nyhan syndrome
congenital spherocytosis
congenital elliptocytosis
congenital stomatocytosis
V,
20
25
30
-55-
congenital Rh null disease
paroxysmal nocturnal hemoglobinuria
G6PD (glucose-6-phosphate dehydrogenase)
variants 1,2,3
v pyruvate kinase deficiency
congenital erythropoietin sensitivity
deficiency
sickle cell disease and trait
thalassemia alpha, beta, gamma
met-hemoglobinemia
10
congenital disorders of immunity
severe combined immunodeficiency disease
(SCID)
bare lymphocyte syndrome
ionophore- r espons ive combined
1*5 ...
immunode f ic lency
combined immunodeficiency
with a capping abnormality
nucleoside phosphorylase deficiency
granulocyte actin deficiency
20 . .
infantile agranulocytosis
Gaucher ' s disease
adenosine deaminase deficiency
Kostmann ' s syndrome
reticular dysgenesis
25
congenital leukocyte dysfunction syndromes
VI . Others
osteopetrosis
myelosclerosis
acquired hemolytic anemias
acquired immunodeficiencies
infectious disorders causing primary or
secondary immunodeficiencies
bacterial infections ( e.g. , Brucellosis,
6h
10
15
20
25
30
•
-56-
Listerosis, tuberculosis, leprosy)
parasitic infections ( e.g. , malaria,
Leishmaniasis)
.fungal infections
disorders involving disproportions in
lymphoid cell sets and impaired
immune functions due to aging
phagocyte disorders
Kostmann' s agranulocytosis
chronic granulomatous disease
Chediak-Higachi syndrome
neutrophil act in deficiency
neutrophil membrane GP-180 deficiency
metabolic storage diseases
mucopolysaccharidoses
mucolipidoses
miscellaneous disorders involving
immune mechanisms
Wiskott-Aldrich Syndrome
alpha 1-antitrypsin deficiency
35
5.6.1. DISEASES RESULTING FROM A FAILURE
OR DYSFUNCTION OF NORMAL BLOOD
CELL PRODUCTION AND MATURATION
In this embodiment of the invention, reconstitution of
the hematopoietic system with neonatal stem and progenitor
cells can be used to treat diseases resulting from a failure
or dysfunction of normal blood cell production and matura-
tion, i.e. , aplastic anemia and hypoprolif erative stem cell
disorders. These disorders entail failure of stem cells in
bone marrow to provide normal numbers of functional blood
cells. The aplastic anemias result from the failure of stem
cells to give rise to the intermediate and mature forms of
red cells, white cells, and platelets. Red cell production
is usually most seriously affected, but a marked decrease in
-57-
production of other mature blood cell elements is also seen.
The large majority of these anemias are acquired during adult
life, and do not have any apparent genetic predisposition.
About half of these acquired anemias arise in the absence of
any obvious causative factor such as exposure to poisons,
drugs or disease processes that impair stem cell function;
these are termed idiopathic aplastic anemias. The remaining
cases are associated with exposure to an extremely diverse
array of chemicals and drugs and can also occur as the
consequence of viral infections such as hepatitis, and after
pregnancy. Other types of aplastic anemia are termed
agranulocytosis or thrombocytopenia to indicate that the
major deficiency lies in particular white cells or in
platelet production, respectively. Agranulocytosis may be
associated with autoimmune syndromes such as systemic lupus
erythematosis (SLE) or with infections, particularly neonatal
rubella.
The overall mortality of all patients with aplastic
anemias, in the absence of stem cell therapy, is high.
Approximately 60-75% of individuals suffering from the
disorder die within 12 months, in the absence of new stem
cells. The overall incidence of these diseases is
approximately 2 5 new cases per million persons per year.
Although it is extremely unlikely that a single pathogenic
mechanism accounts for all aplastic anemias, it is clear that
provision of new hematopoietic stem cells is usually
sufficient to allow permanent recovery, since transplantation
of patients with aplastic anemia with bone marrow obtained
from identical twins (i.e. , syngeneic) (Pillow, R.P., et al.,
1966, N, Engl, J, Med, 275 (2) : 94-97 ) or from HLA-identical
siblings ( i , e, , allogeneic) (Thomas, E,D,, et al,, Feb. 5,
1972, The Lancet, pp, 284-289) can fully correct the disease.
However, some patients with aplastic anemia reject the
transplanted marrow. This complication is particularly
common among patients who have been immunologically
35
-58-
sensitized as a result of multiple therapeutic blood
transfusions. In a preferred embodiment of the invention
employing autologous neonatal stem cells for hematopoietic
reconstitution, such a complication can be avoided.
In a specific embodiment of the invention, hematopoietic -
reconstitution by infusion of neonatal stem cells can be used
for the treatment of Fanconi's anemia, an autosomal recessive
disease exhibited by congenital malformations associated with
bone marrow failure. The stem cell defect is associated with
chromosomal instability, and increased risk for malignancy.
The disease is always fatal in its natural course. This
embodiment of the invention is illustrated by way of example
in Section 12, infra , which describes the infusion of
neonatal blood comprising hematopoietic stem and progenitor
cells into a patient with Fanconi's anemia for treatment of
the disease. In a preferred aspect of this embodiment, the
patient is conditioned before stem cell infusion, by a
conditioning regimen which is modified according to cell
sensitivity to alkylating agents and to irradiation ( see
Gluckman, E. , et al. , 1983, Brit. J.. Haematol. 54:431-440;
Gluckman, E. , et al., 1984, Seminars in Haematol. 21(1): 20-
26; Gluckman, E. and Dutreix, J., 1985, The Cancer Bulletin
37 (5) : 238-242 ; Gluckman, E. , et al., 1980, Brit. J. Haematol.
45:557-564; all incorporated by reference herein). For
example, cytogenetic analysis can be used to predict cell
sensitivity to alkylating agents (Berger, R. , et al., 1980,
Brit. J. Haematol. 45:565-568). Tests for radiosensitivity
have also been described (Gluckman, E. and Dutreix, J., 1985,
The Cancer Bulletin 37 (5) : 238-242 ; Gluckman, E. , et al.,
1983, Brit. J. Haematol. 54:431-440). In a particular
embodiment, a conditioning regimen using cyclophoshamide and
thoraco-abdominal irradiation can be employed.
35
5?
-59-
5.6.2, HEMATOPOIETIC MALIGNANCIES
Hyperprol iterative malignant, stem cell disorders which
can be treated by hematopoietic reconstitution with neonatal
stem and progenitor cells include but are not limited to
acute lymphocytic leukemia, chronic lymphocytic leukemia,
5
acute and chronic myelogenous leukemia, multiple myelomas,
polycythemia vera, agnogenic myelometaplasia , Waldenstrom's
macroglobulinemia, and Hodgkins and non-Hodgkins lymphoma.
These leukemias are currently treated by chemotherapy and,
when feasible, allogeneic bone marrow transplantation.
10
However, allogeneic HLA identical sibling bone marrow is
available only to less than one-third of patients, and this
treatment is associated with transplantation-related compli-
cations such as immunodeficiency and graft versus host dis-
ease. Provision of syngeneic (self) cryopreserved hemato-
1 5
poietic stem cells, according to a preferred embodiment of
the invention, would permit hematopoietic reconstitution of
patients lacking suitable allogeneic donors and eliminate the
risks of graft versus host disease arising from allogeneic
marrow transplantation.
20
5.6.3. MALIGNANT, SOLID TUMORS OF
NON-HEMATOPOIETIC ORIGIN
Hematopoietic reconstitution can greatly aid in the
treatment of patients with malignant, solid tumors undergoing
25 irradiation or chemotherapy, by providing new stem cells.
Such tumors include but are not limited to those listed in
Table II, supra .
There is increasing evidence that a number of cancers
are remarkably sensitive to extremely high doses of normally
30 ineffective anti-neoplastic drugs. These cancers include
malignant melanoma, carcinomas of the stomach, ovary, and
breast, small cell carcinoma of the lung, and malignant
tumors of childhood (including retinoblastoma and testicular
carcinoma), as well as certain brain tumors, particularly
-60-
glioblastoma. However, such intensive high dose chemotherapy
is not widely used because it frequently causes hematopoietic
failure and death. The provision of new stem cells after
intensive chemotherapy has been accomplished by using bone
marrow cells obtained from patients befc_*e administration of
the cytotoxic drugs (Spitzer, G. , et al., 1980, Cancer
45:3075-3085). This approach has two major difficulties.
First, it has not been routinely possible to obtain
sufficient numbers of bone marrow cells from chronically ill
patients with cancer. In addition, clinicians have been
reluctant to use this approach because of the probability
that the patient's bone marrow cells are contaminated by
small numbers of neoplastic cells. This is particularly true
in the hematologic malignancies, but also pertains to most
metastatic cancers. The provision of stem cells according to
the present invention, obtained at a time of health, before
the onset of cancer, can permit the use of potentially
curative intensive chemotherapy without the risk of stem cell
failure.
5.6.4. AUTOIMMUNE DISORDERS
Many chronic inflammatory and degenerative diseases are
characterized by a continuous immune reaction against the
body's own tissues. Such autoimmune disorders include but
are not limited to rheumatoid arthritis and other inflam-
matory osteopathies, diabetes type I, chronic hepatitis,
multiple sclerosis, and systemic lupus erythematosus.
Autoimmune disorders are often treated by lymphoid irradi-
ation. Use of the neonatal hematopoietic stem and progenitor
cells for hematopoietic reconstitution according to the
present invention can be extremely valuable after radio-
therapy.
Anti-inflammatory drugs such as steroids retard the
inflammatory cells which are activated by autoreactive T
cells, but do not prevent T cells which recognize self-
10
15
20
25
30
35
-61-
proteins from activating new inflammatory cells. A more
direct approach to treating autoimmune diseases depends on
eradication of T cells by irradiation of the lymphoid
tissues, and relying on stem cells from the unirradiated bone
marrow to repopulate the patient ' s hematopoietic system. The
rationale is that the formation of new populations of mature
T cells from bone marrow stem cells may result in absence of
T cells that have reactivity to self-specific antigens. This
procedure, called total lymphoid irradiation (TLI) , has been
used to treat intractable rheumatoid arthritis (Strober, S.,
et al., 1985, Annals of Internal Medicine 102:441-449, 450-
4 58) . These clinical trials showed that in the majority of
otherwise intractable cases, joint disease was significantly
alleviated for at least 2-3 years. However, the major
drawback to such treatment is failure of stem cells in the
bone marrow of these elderly patients to efficiently
repopulate the hematopoietic sytem, resulting in infections
and bleeding disorders. Analogous studies have been made of
the effects of TLI as an alternative to cytotoxic drugs for
treatment of SLE (Strober, S., et al., 1985, Ann. Internal
Med, 102:450). Studies of the use of TLI to treat
intractable SLE have also shown that this treatment
alleviates disease activity, but is severely limited by
failure of bone marrow stem cells to rapidly and efficiently
repopulate the hematopoietic system after irradiation. In a
preferred aspect of the invention, the availability of an
individual's own stem cells, obtained at birth, can allow
efficient repopulation of mature T cells in an adult
environment, after minimal lymphoid radiotherapy, and can
thus render this therapy significantly more effective.
5.6.5. GENE THERAPY
Hematopoietic reconst itution with the neonatal stem and
progenitor cells of the invention which have undergone gene
therapy, i.e. , which have stably incorporated a heterologous
-62-
gene capable of expression by their progeny cells, can be of
great value in the treatment of diseases and disorders
affecting cells of hematopoietic lineage * In one embodiment,
hematopoietic reconstitution with such recombinant stem cells
can be used in the treatment of genetic disorders of the
hematopoietic system. Such genetic disorders include but are
not limited to those listed in Table II, supra . Genetic
deficiencies or dysfunctions of hematopoietic cells can be
treated by supplying, to a patient, recombinant stem and
progenitor cells. In a specific embodiment, patients who
have hematopoietic cells which lack a gene or have a mutant
gene, can be reconstituted with neonatal stem and progenitor
cells that have incorporated a functional counterpart of the
deficient gene. In particular, such genes which can be
subject to gene therapy include but are not limited to
hemoglobin or enzymes which mediate its synthetic pathway
( e.g. , for treatment of anemias such as beta-thalassemia,
sickle-cell disease) .
In another specific embodiment, patients with infections
by pathogenic microorganisms which occur in or affect a
hematopoietic cell lineage can be treated with recombinant
neonatal stem and progenitor cells. Such recombinant stem
and progenitors can contain a heterologous gene which is
expressed as a product which ameliorates disease symptoms, is
toxic to the pathogen without significant detriment to the
host, or interferes with the pathogen's life cycle, etc.
Pathogens which cause infections which may be treated with
recombinant stem cells according to this embodiment of the
invention include but are not limited to lymphotropic viruses
such as Human Immunodeficiency Virus (HIV, the etiological
agent of acquired immune deficiency symdrome (AIDS)) (Gallo
et al., 1984, Science 224:500-503; Barre-Sinoussi , F. , et
al., 1983, Science 220:868; Levy, J. A. , et al., 1984, Science
225:840); gram-negative bacilli such as Brucella or Listeria ;
the mycobacterium which cause tuberculosis, or which cause
10
15
20
25
30
35
-63-
Hansen's disease (leprosy) ; parasites such as Plasmodium (the
etiological agents of malaria) , or Leishmania ; and fungi
(such as those that cause pneumonia and other lethal
infections secondary to immunodeficiencies) (for a discussion
of many of these disorders, see Harrison's Principles of
Internal Medicine, 1970, 6th Edition, Wintrobe, M.M., et al.,
eds., McGraw-Hill, New York, pp. 798-1044). As a particular
embodiment, it is possible to construct recombinant neonatal
stem or progenitor cells that express a sequence which is
"anti-sense* to the nucleic acid of a hematopoietic cell
pathogen. Such a sequence, which is complementary to the
pathogen's RNA or DNA, can hybridize to and inactivate such
RNA or DNA, inhibiting the function or expression of the
nucleic acid and disrupting the pathogen's life cycle. As a
particular example, recombinant neonatal hematopoietic cells
can be used in the treatment of AIDS, a disorder which is
caused by HIV, apparently by infection of T4 + lymphocytes
(Dagleish et al., 1984, Nature 312:763-766; Klatzmann et al.,
1984, Nature 312:767-768). Recombinant neonatal stem and
progenitor cells which express an anti-sense nucleic acid
that is complementary to a critical region ( e.g. , the long-
terminal repeat or polymerase sequence ) of the HIV genome
(Wain-Hobson et al., 1985, Cell 40:9-17) can be used for
hematopoietic reconstitution for the treatment of AIDS.
Numerous techniques are known in the art for the
introduction of foreign genes into cells and may be used to
construct the recombinant neonatal hemapoietic stem and
progenitor cells for purposes of gene therapy, in accordance
with this embodiment of the invention. The technique used
should provide for the stable transfer of the heterologous
gene sequence to the stem cell, so that the heterologous gene
sequence is heritable and expressible by stem cell progeny,
and so that the necessary developmental and physiological
functions of the recipient cells are not disrupted. Tech-
niques which may be used include but are not limited to
-64-
chromosome transfer ( e.g. , cell fusion, chromosome-mediated
gene transfer, micro cell-mediated gene transfer) , physical
methods ( e.g. , transf ect ion , spheroplast fusion, microin-
jection, electroporation, liposome carrier) , viral vector
transfer ( e.g. , recombinant DNA viruses, recombinant RNA
viruses) etc. (described in-Cline, M.J., 1985, Pharmac.
Ther. 29:69-92, incorporated by reference herein).
5.6.6. MISCELLANEOUS DISORDERS
INVOLVING IMMUNE MECHANISMS
10 Hematopoietic reconstitution with the neonatal hemato-
poietic stem and progenitor cells of the present invention
can be used to treat patients with various miscellaneous
disorders involving immune mechanisms. Disorders resulting
from inefficient function, lack of function, or dysfunction,
1 5 of an hematopoietic cell lineage can be alleviated by
replacement of the hematopoietic cell progeny with those
derived from neonatal stem and progenitor cells of normal
function. In a specific embodiment, a hemolytic disorder can
be treated (for a discussion of hemolytic disorders, see
20 e.g. , 1985, Cecil, Textbook of Medicine, Wyngaarden, J.B. and
Smith, L.H., eds . , 17th Ed., W.B. Saunders Co., pp. 900-915).
Hemolytic disorders acquired during adult life account for
the large majority of this form of anemia, and reflect the
destruction of red cells by lymphocyte products. Stem cell
25 replacement therapy with the neonatal cells of the invention
can provide a new source of red cells, and, in an embodiment
employing autologous cells, can replace destructive
lymphocytes with newly formed cells which are unlikely to
generate an immune response against the recipient's red
30 cells. In another specific embodiment, patients whose immune
system is compromised e.g. , as a result of irradiation or
chemotherapy, can be treated by hematopoietic reconstitution
with neonatal hemapoietic stem and progenitor cells (see
Section 5.6.3). In yet another embodiment, disorders
35
-65-
involving disproportions in lymphoid cell sets and impaired
immune functions due to aging can be treated by
reconstitution with the neonatal cells of the invention.
Genetic disorders of metabolism which result in pathologic
accumulations of metabolic products in the marrow ( e.g. ,
osteopetrosis, metabolic storage diseases) are also among the
many disorders envisioned for treatment.
In addition , immune deficiencies which are the primary
or secondary result of infection by pathogenic microorganisms
can be treated by hematopoietic reconstitution with the stem
cells of the invention. In this embodiment, neonatal stem
cells can serve as a source of cells of the hematopoietic
cell lineage which are needed by the patient. For example,
immune deficiencies caused by microorganisms which are
intracellular pathogens of hematopoietic cells, can be
treated by the provision of new hematopoietic cells, supplied
by infused neonatal stem cells. Microorganisms causing
immune deficiencies which may be treated according to this
embodiment of the invention include but are not limited to
gram-negative bacilli such as Brucella or Listeria , the
mycobacterium which are the etiological agents of
tuberculosis or of Hansen's disease (leprosy) , parasites such
as Plasmodium (the etiological agents of malaria) or
Leishmania , and fungi (such as those that cause pneumonia and
other lethal infections secondary to immunodeficiencies) (for
a discussion of many of these disorders, see Harrison's
Principles of Internal Medicine, 1970, 6th Edition, Wintrobe,
M.M., et al., eds., McGraw-Hill, New York, pp. 798-1044).
In another method of the invention, progeny cells of
hematopoietic stem and progenitor cells of fetal or neonatal
blood can be generated in vitro ; the differentiated progeny
cells thus generated can be therapeutically useful. For
30
5.7
GENERATION AND USE OF HEMATOPOIETIC
STEM AND PROGENITOR CELL PROGENY
35
-66-
example, in one embodiment of this aspect of the invention,
hematopoietic stem cells and/or CFU— GEMM progenitor cells,
before or after cryopreservation and thawing, can be induced
to differentiate into platelets. Such platelets can be used,
for example, for infusion into a patient with
5
thrombocytopenia. In another embodiment, granulocytes can be
generated in vitro prior to infusion into a patient. One or
more of the hematopoietic progeny cells can be generated in
vitro , allowing for the in vitro production of blood com-
ponents. In a preferred embodiment, the generation of
10 differentiated blood components is accompanied by expansion
of the hematopoietic stem and progenitor cell pool, in order
to allow for production of a greater quantity of differen-
tiated cells. Various growth factors can be used to promote
expansion and/or differentiation of hematopoietic stem and
15
progenitor cells, such as cytokines (growth factors)
including but not limited to G-CSF, CSF-1, IL-3 , IL-5, tumor
necrosis factor-a, and 7-interf eron. The blood components
which are thus produced have uses which are not limited to
therapeutic uses in vivo . For example, such progeny cells
20
can be used in vitro , e.g., for the production and isolation
of hematopoietic cell products such as growth factors,
antibodies, etc.
6. EXAMPLES
25
6.1. COLLECTION OF HUMAN UMBILICAL
CORD AND PLACENTAL BLOOD
Neonatal blood was collected from human umbilical cords
by gravity drainage and/or by needle aspiration from deliv-
30 ered placentas. Data for the volumes obtained in one series
of collections from individual births is shown in Figure 1,
and demonstrates that volumes of 50 ml or more can be
obtained. Data from another series of collections is shown
in Figure 2, with the collections from individual births
35
# •
-67-
10
15
20
30
identified by method of collection and delivery type, as
either: gravity flow, vaginal delivery; gravity flow,
Caesarian section; placental aspiration, vaginal delivery;, or
placental aspiration, Caesarian section. The data show that
the majority of the collections had a total volume of greater
than 30 ml although many contained less than 50 ml. In
recent collections, we have been able to obtain volumes
approximately twice as large as shown in Figure 2 ( e.g. , 99
ml blood from a neonate, after a 36 week gestation) by using
needle aspirations from the delivered placenta, at the root
of the placenta and in the distended surface veins, combined
with cord drainage.
Cord blood collections were done essentially as
described in Section 5.1.1 and subsections, supra , and as
detailed infra.
Cord blood collection kits consisted of:
wide-mouth bottle (200 ml) (Corning, Corning, NY) ,
Cat. No. 25625-200; VWR, South Plainfield,
NJ, Cat. No. 28199-756)
wrap (operating room drape sheet)
For collections by needle aspiration, 60 cc syringes B-D
Luerlok (VWR, Cat. No. BD5663) and 18 gauge needles 1 1/2
inch (VWR, Cat. No. BD5196) were used.
Collection bottles were sterilized before collection by
beta-irradiation with 2.5 megarads from a tungsten source
25 (Dynamatron Accelerator, Radiation Dynamics, Inc., Melville,
New York) „ Syringes and needles were autoclaved. (Alterna-
tively, the syringes and needles were sterilized with ethy-
lene oxide. )
Twenty ml of CPD (citrate-phosphate-dextrose) was added
to each cord blood collection container, as an anti-
coagulent. CPD was prepared according to the following:
Trisodium citrate (dihydrate) 28.8 g
Citric acid (monohydrate) 3.2 g
Sodium dihydrogen phosphate 2.19 g
10
15
-68-
( monohydra t e )
Dextrose 2 5 . 0 g
" Bring volume to 1,000 ml; pH should be 5,63. Use
at 2 0 ml CPD per up to approximately 120 ml blood.
In selected samples, acid-citrate-dextrose (ACD) (Hurn,
B.A.L., 19 68, Storage of Blood, Academic Press, New York, p.
137) was used instead of CPD. ACD was prepared according to
the following:
Trisodium citrate (dihydrate) 1,65 g
Citric acid (monohydrate) 1.983 g
Dextrose (anhydrous) 6.13 g
in a total volume of 2 50 ml
The substitution of ACD for CPD caused no observable
differences in the hematopoietic stem and progenitor cell
counts which were obtained.
Penicillin and streptomycin were also added to the
collected blood. 0.01 X cord blood volume, of a solution
consisting of 5000 units penicillin per ml and 500 ug
streptomycin per ml, was added to each cord blood sample.
Approximately 109 of the human umbilical cord blood
samples which were collected were subjected to further
analysis as described infra .
6.2. HEMATOPOIETIC STEM AND PROGENITOR
CELLS IN COLLECTED CORD BLOOD
25 The approximately 109 collected cord blood samples of
section 6.1 were sent by overnight mail (in polystyrene
mailers; Fisher, Fairhaven, New Jersey, Cat. No. 03-528-10)
to a processing site where they were separated, counted for
viable cell numbers, set up for hematopoietic progenitor cell
30 assays (in most cases), frozen away for storage, and in some
cases defrosted for assessment of recovery of total nucleated
cells and hematopoietic progenitors (see Section 6.7, infra ) .
The progenitor cells evaluated included immature and mature
granulocyte-macrophage (day 7 CFU-GM, day 14 CFU-GM) ,
35
20
-69-
"immature* and "mature" erythroid (BFU-E-1, BFU-E-2) , and
multipotential cells (see Section 6.6 and subsections, infra
for assays of progenitor cells) . Table III presents a
complete list of the samples received and the numbers of
hematopoietic progenitor cells per sample present in the low
density fraction after separation with Ficoll-Hypaque.
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From receipt, of the samples until the cells were frozen,
16 hours were spent in processing the cells. (This time
period included cell separation on Ficoll-Hypaque, counting
the cells, setting up the progenitor cell assays, and freez-
ing the cells) .
As shown in Table III, significant total numbers of
progenitors cells were obtained even with the overnight tran-
sit time plus 16 hour processing- Even among the samples in
transit for 48 hours, viable progenitor cells were observed.
There was variability among donors in the observed number of
progenitor cells. It should be noted that the values shown
in Table III represent remaining progenitor cells after loss
of progenitors due to cell separation procedures (see Table
IV, infra ) .
15 6.3. ENRICHMENT FOR HUMAN HEMATOPOIETIC
STEM AND PROGENITOR CELLS: CELL
SEPARATION PROCEDURES
In a preferred embodiment of the invention, whole
neonatal blood can be cryogenically preserved, and used for
hematopoietic reconstitution after thawing, in order to avoid
cell losses associated with cell separation procedures.
However, it is envisioned that cell separation procedures can
be used if desired, e.g. , to minimize blood storage volumes.
Thus, in the examples sections herein, cell separation
procedures are described which can be used to enrich for
neonatal hematopoietic stem cells in collected blood. Many
of the procedures relate to the enrichment of stem cells
derived from adult bone marrow or adult blood, however, it is
envisioned that the same procedures, or modifications there-
of, are equally applicable to the neonatal hematopoietic stem
cells of the present invention.
Human stem and progenitor cells are present in the non-
adherent, low density, T-lymphocyte-depleted fraction of bone
marrow, spleen, and (adult and cord) blood cells. Purifica-
tion or enrichment for the stem and progenitor cells has been
35
20
25
30
-76-
carried out by Ficoll-Hypaque density separation, adherence/
non-adherence separation, and positive selection by antibody
binding.
10
15
20
25
30
6.3*1- DENSITY SEPARATIONS .
Enrichment for human hematopoietic stem and progenitor
cells has been carried out by isolation of low density
(density less than 1.077 gm/cm 3 ) cells separated by Ficoll-
Hypaque (Pharmacia Fine Chemicals, Piscataway, NJ) .
The following protocol is used for samples of bone
marrow or peripheral blood:
1. Obtain sample of bone marrow or peripheral blood.
Bone Marrow - sample should be 1-5 ml containing
heparin. Place in sterile 17 X 100 mm
tube. Add 2-3 ml of sterile DPBS
(phosphate-buffered saline without
magnesium or calcium). Mix well.
Whole Blood - Dilute sample at least 1:1 with McCoy's 5A
medium or DPBS. Adjust volume to a
multiple of 20 ml.
2. Bone Marrow - spin for 10 minutes at approximately 400 X
g (1500 rpm; Beckman TJ-6R rotor) at 4°C.
Whole Blood - Go to next step.
3. Bone Marrow - Remove buffy coat and wash once with DPBS.
Resuspend to a final volume of 20-40 ml
(if 1-2 pulls of 2 ml each, resuspend to
20 ml; if 3-5 pulls, resuspend to 40 ml).
Count cells; adjust volume to a maximum of
6 X 10 7 cells per 20 ml.
Whole Blood - Go to next step.
4. Bone Marrow - With a 10 ml pipet, carefully layer 20 ml
of buffy coat suspension onto 15 ml of
Ficoll-Hypaque in a 50 ml polypropylene
tube.
35
Whole Blood - With a 10 ml pipet, carefully layer 20 ml
of blood suspension onto 15 ml Ficoll-
Hypaque in a 50 ml polypropylene tube.
5. Using a balance, carefully adjust weight of tube(s) with
blank(s) -
6. With slow acceleration, centrifuge sample (s) at 400 X g
(1500 rpm) for 3 0 minutes at 4°C. Turn brake off.
7. Carefully remove the low density band and place it in a
clean sterile tube. Dilute at least 1:10 with McCoy's 5A
medium or DPBS.
8. Wash cells twice by centrif ugation at 400 X g for 10
minutes at 4°C. Resuspend to 50 ml and repeat.
9. Final resuspension should be to 10-15 ml with McCoy's
media.
10. Perform cell count.
The following modification of the above procedure has
been used for cord blood separations (and was used in
obtaining the data shown in Tables III and IV) :
1.. Obtain cord blood, aseptically, using a 60 cc syringe
containing 3 000-4000 units of preservative-free sodium
heparin or ACD as an anticoagulant.
2. Perform low density cell separation using Ficoll-Hypaque
density gradient, by diluting cord blood with sterile DPBS
(phosphate buffered saline without Mg ++ , Ca ++ ) , pH 7.0, at a
ratio of 1:3 (cord blood: PBS). Layer 20 ml of blood
suspension on 15 ml of Ficoll-Hypaque in a 50 ml polypropy-
lene centrifuge tube (Fig. 3). Centrifuge at 4°C, 400 X g,
for 30 minutes.
3. Collect and pool all low density cell bands (Fig. 4)
from each individual donor. Make sure that very little
Ficoll-Hypaque is collected with cells, or the cells may not
pellet through the collected Ficoll. Dilute the cell
suspensions 1:1; if "X" ml of cells were collected, dilute
with "X" ml of DPBS in order to dilute collected Ficoll
-78-
sufficiently to allow cells to pellet. Pellet cells by
centrifugation at 4°C, 200 X g, for 10 minutes.
4. Aspirate and discard supernatant from each pellet. If
several tubes were used, pool identical donor pellets after
resuspending each pellet with 5 ml of DPBS. Pellet cells by
centrifugation at 4°C, 200 X g, for 10 minutes.
5. Aspirate and discard supernatant. Resuspend pellet in
10 ml of DPBS using a 10 ml pipet and gentle up-down
aspirations. Bring volume to 50 ml with DPBS. Pellet cells
by centrifugation at 4°C, 200 X g for 10 minutes.
6. Resuspend in RPMI-1640 medium supplemented with 5%
autologous plasma or heat-inactivated fetal calf serum (FCS) .
Perform cell counts and viability. Keep cell suspension
chilled to 4 °C.
The effect of various density separation procedures on
the yield of progenitor cells in the human cord blood
collected (described in Section 6.1, supra ) was assessed. We
have compared the number of progenitors in whole blood, no
separation treatment, to that of whole blood in which the
mature erythrocytes were lysed by treatment with ammonium
chloride (NH 4 C1) , low density cells after Ficoll-Hypaque
separation (density less than 1.077 gm/cm 3 ) , heavy density
cells after Ficoll-Hypaque separation, and heavy density
cells after treatment with NH 4 C1 to lyse the erythrocytes
(Table IV, Exp. 1) .
25
30
35
-79-
10
\J 25
TABLE IV
COMPARISON OF HEMATOPOIETIC PROGENITOR CELLS
OBTAINED WITH DIFFERENT CELL SEPARATION PROCEDURES
Progenitor Cells X 10~ 3
Separation CFU-GM CFU-GM CFU-
Procedure day 7 day 14 BFU-E-2 BFU-E-1 GEMM
Exp #1
None (Whole Blood)
167
220
330
356
356
Whole Blood + NH„C1
55
112
43
39
43
Low Density (Ficoll)
35
87
49
23
36
Heavy Density (Ficoll)
49
104
71
82
153
Heavy Density + NH 4 Cl
17
40
17
14
11
Exp #2
None (Whole Blood)
561
1020
612
484
408
Whole Blood Sedimented
with Methyl Cellulose
157
388
212
286
111
Low Density (Ficoll)
256
653
506
448
186
Heavy Density (Ficoll)
3
8
8
14
5
Exp #3
Sample CB-57
Whole Blood Sedimented
with Methyl Cellulose
6
12
11
12
6
Low Density (Ficoll)
35
59
30
76
37
Sample CB-58
Whole Blood Sedimented
with Methyl Cellulose
5
14
14
17
7
Low Density (Ficoll)
16
30
31
43
26
35
Sample CB-59
Whole Blood Sedimented
-80-
with Methyl Cellulose 6 21 31 39 17
Low Density (Ficoll) 13 52 64 67. 43
Sample CB-60
Whole Blood Sedimented
with Methyl Cellulose 2 9 5 4 0
Low Density (Ficoll) 3 40 18 18 6
As shown in Table IV, Exp. 1, there are many more
progenitors detected in the unseparated blood than in the low
10 density Ficoll preparation. This difference is not due to
loss of cells into the dense fraction of Ficoll, which
contains mainly mature neutrophilic granulocytes. Lysing
whole blood erythrocytes also resulted in a lower yield of
progenitors. In experiment number 2, we compared whole
15 blood, whole blood that was sedimented with methyl cellulose
to remove erythrocytes, and low and high density Ficoll
separated cells. The results demonstrated that whole blood
contained the most progenitors, some of which were lost from
the fraction of cells obtained after sedimentation of the
20 er Y throc ytes with methyl cellulose. As seen in both
experiments 2 and 3 of Table IV, sedimenting cells with
methyl cellulose was inferior to the low density fraction of
Ficoll with respect to numbers of progenitors. While the
Ficoll separation removed mature granulocytes and erythro-
25 c Y tes from the progenitor cell fraction, some progenitors
were also lost, relative to whole blood, using this
procedure .
6.3.2. ADHERENCE/NON-ADHERENCE SEPARATION
3q An adherence/non-adherence separation protocol for
enrichment of hematopoietic stem and progenitor cells is as
follows :
1. In a 60 mm Corning tissue culture dish, seed 10-15 x 10 6
low density cells in up to 3 ml of McCoy's 5A (supplemented)
35 media with 10% fetal calf serum (heat-inactivated) .
-81-
2. Incubate for 1.5 hours at 37 °C in an atmosphere of 5%
co 2 .
3. Gently swirl plate to loosen non-adherent cells. Pipet
into sterile centrifuge tube. Carefully rinse dish with 3 ml
iXCoy's media and pool the media.
4. Add 1 ml McCoy's media to the dish, and gently remove the
cells with a sterile rubber policeman. Remove the cells and
place them in a sterile centrifuge tube. Rinse the dish with
3 ml media and pool media.
5. Pellet cells by centrif ugation at 400 X g for 10 minutes
at 4°C. Aspirate the supernatant and resuspend the cells in
media.
6 . Repeat step 5 .
7. Perform cell count.
The following protocol has been used for
cryopreservation of viable hematopoietic stem and progenitor
cells derived from human cord and placental blood:
20 1- Pellet low density, Ficoll-separated cells by
centrif ugation at 4*C, 2 00 X g for 10 minutes.
2. Check viable cell count by trypan blue exclusion
(Kuchler, R.J., 1977, Biochemical Methods in Cell Culture and
Virology, Dowden, Hutchinson & Ross, Stroudsburg, Pa., pp.
25 18-19) and manual cell counting using a hemocytometer .
3. Gently resuspend cells to a concentration of 4 x 10 6
viable cells/ml, using a mixture of cold (4°C) 50% autologous
plasma/RPMI-1640 or 50% heat-inactivated FCS/RPMI, and place
the suspension on ice.
30 4 . In a cryovial containing 1 ml of a chilled, sterile
cryoprotective medium of 20% DMSO/RPMI-164 0 , carefully layer
a 1 ml portion of the aforementioned cell suspension on top
of the cryoprotective medium.
6.4.
CRYOPRESERVATION OF CORD BLOOD
STEM AND PROGENITOR CELLS
-82-
10
15
20
25
30
5. Approximately 10 minutes prior to freezing, slowly invert
the 1:1 mixture to promote mixing, then place it on ice to
allow equilibrium between the cells and the cryoprotective
medium. NOTE: The "layered" tube should not remain unfrozen
for very, -long, so freezing should preferably be done within
20-30 minutes after exposure of cells to DMSO/RPMI solution.
6. Place the vials in a freezing rack, which in turn is
placed in a 4°C methanol bath, just deep enough to cover the
cell suspension (Fig. 4), This is then placed in the bottom
(to ensure proper temperature) of a -80 °C freezer for at
least 2 hours and less than 24 hours,
7. After cells reach the frozen state, carefully and quickly
transfer them to a long term liquid nitrogen containment
vessel. A cryogenic storage vessel which can be used is the
LR1000 refrigerator (Union Carbide Corp., Indianapolis,
Indiana) which accommodates up to 4 0,000 cryules.
6.5. CELL THAWING
The following protocol has been used for thawing of
cryopreserved cord blood stem and progenitor cells:
1. Remove vial of frozen cells from liquid nitrogen.
Immediately thaw cell suspension by gently agitating the vial
in a 37 °c water bath until just a small amount of ice
remains.
2. Aseptically, begin to add drop-wise, a chilled mixture of
50% autologous serum/RPMI-1640 medium or 50% FCS/RPMI-1640
medium with a slight mixing between each drop, until the
suspension volume is doubled.
3. Transfer this suspension to a larger centrifuge tube
(12-15 ml) and continue to add, drop-wise, 50% serum/RPMI
mixture with mixing between every other drop until the volume
reaches 6-7 ml. Diluent may now be added, drop-wise, with
mixing at every 0.5 ml increment until the volume reaches
35
-83-
9-10 ml. (NOTE: The reason for stepwise addition of diluent
is to prevent osmotic shock to the cells as DMSO is diluted
in the cell suspension.)
4. Pellet cells by centrifugation at 4°C, 200 X g, for 10
minutes. Aspira^a the supernatant.
5. Slowly add, drop-wise, 1 ml of chilled 20% autologous
serum/RPMI-1640 mixture to the pellet. 'Resuspend* the
pellet by gently "flicking" the tube with a finger. After
the pellet is resuspended (clumps may remain) , resuspend it
further by gently aspirating up and down with a 1 ml pipet.
6. Add an additional 4 ml chilled 20% autologous serum/RPMI,
dropwise, with mixing between every drop; then add 0.5 ml as
volume increases, as previously described.
7. Pellet cells by centrifugation at 4°C, 200 X g, for 10
minutes. Aspirate the supernatant.
8. Resuspend with 2-5 ml of chilled 20% serum/RPMI mixture.
9. Perform cell counts (by use of a hemocytometer) and
viability testing (by trypan blue exclusion) .
Loss of cells due to clumping during the stepwise
removal of DMSO can be diminished by including DNase (20 U
per 2 x 10 6 cells) or low molecular weight dextran and
citrate (to reduce the pH to 6.5).
Assays which can be used to quantitatively assess human
hematopoietic stem and progenitor cells are described in the
following examples sections. The assays for granulocyte-
macrophage (CFU-GM) , erythroid (BFU-E) , and multipotential
30 (CFU-GEMM) progenitor cells (Sections 6.6.1 and 6.6.2) were
used to derive part of the data for human cord blood cells
that is presented in Table III, supra .
6.6.
HUMAN HEMATOPOIETIC STEM AND
PROGENITOR CELL ASSAYS
25
35
10
15
-84-
6-6.1. CFU-GM ASSAY
The following assay has been used to quantify CFU-GM:
1. Obtain a suspension of cells (cord blood, bone marrow,
spleen, cell line, etc.) at a known cell concentration. The
cell suspension concentration should be at least 10 fold
greater than the final concentration desired in the plate.
2. Depending on the number of plates to be plated, the
volume of the culture mixture will vary. As an example, a 10
ml suspension can be made, as described:
In a 17 x 10 mm polystyrene tube, combine the following
components except for the Agar (0.6%) and cells.*
10 ml
Agar (0.6% w/v) 5 ml (50%)
(bacto-agar, Difco Corp.)
**2X McCoys 5A 2 ml (20%)
FCS (heat inactivated) 1 ml (10%)
***Stimulator 1 ml (10%)
♦Cells 1 m i (10%)
* The cells are added just before adding the melted Agar,
in order to avoid allowing the cells to sit in 2X McCoys
for very long. Since the Agar has been boiled, care
should be taken to allow it to cool sufficiently.
** This volume may vary if the cells are more concentrated
than desired. Example: if cells were to be plated at a
final cell concentration of 1 x 10 5 cells/ml, and the
stock cell suspension was 5 X 10 5 cells/ml instead of 1 x
10 cells/ml, 0.2 ml cells would be used, plus 0.8 ml Of
2x McCoys to achieve a 1 ml volume. In general, whatever
volume is lacking after adding the other components, is
made up with 2x McCoy's. (See Section 6.6.1.1, infra for
the preparation of McCoy's medium) .
*** Colony formation can be stimulated by factors present in
medium conditioned by the 5637 urinary bladder carcinoma
cell line (see Section 6.6.1.2 infra), which was used
# •
-85-
routinely, or medium conditioned by the PHAL cell line
(phytohemagglutinin-stimulated leukocytes from patients
with hemochromatosis; Lu, L. and Broxmeyer, H.E., 1985,
Exp. Hematol. 13:989-993), or by purified growth factors.
Growth factors which may be Lasted for human colony
stimulation include but are not limited to interleukin-3
(IL-3) , granulocyte-macrophage (GM) -colony stimulating
factor (CSF) , granulocyte (G)-CSF, macrophage (M) -CSF
(also referred to as CSF-1) , erythropoietin, IL-1, IL-4
(also called B-cell growth factor) and E-type
prostaglandins. (These molecules are available in
purified form from various companies, e.g. , Cetus,
Immunex, and Amgen.) For murine cell assays, pokeweed
mitogen spleen cell conditioned media may be used (see
Section 6.6.1.3, infra ) .
/
3. After the Agar has sufficiently cooled, add the appropri-
ate volume of cells and 0.6% Agar.
4. Place a cap on the tube, and mix the suspension well. A
vortex may be used, but with caution.
5. With an appropriate pipet, place 1 ml of the culture
suspension into a 10 x 35 mm dish, containing colony
stimulating factors if so desired. After all the dishes have
been plated, allow them to solidify.
6. Label the tray of plates and place it in the appropriate
incubator. Incubation is conducted in a humidified atmos-
phere of 5% C0 2 at low oxygen tension (5% 0 2 ) for 7 days and
14 days. Low oxygen tension enhances the detection of CFU-
GM, BFU-E , and CFU-GEMM cells.
7. Remove plates from the incubator and score by
observation of colonies under an inverted or stereoscopic
microscope. Colonies scored at 7 and 14 days represent
maturation stages of CFU-GM cells. (Day 7 CFU-GM represent a
later or more mature progenitor of the granulocyte-macrophage
-86-
lineage, while day 14 CFU-GM represent an earlier progenitor
of the granulocyte-macrophage lineage) .
10
15
6.6.1.1. PREPARATION OF McCOY / S 5A MEDIUM
The following procedure was used to prepare IX McCoy's
5A Medium:
1* 1 envelope McCoy's 5A medium (Gibco #430-1500)
NaHCO,
2.2 gm
Bring to 1 liter with double-distilled H 2 0; pH to 7.0-
7.2.
2. Filter-sterilize by use of a 0.2 urn filter and peristal-
tic pump (positive pressure) .
3. If medium is to be used for growth or incubation, it is
supplemented with the following:
Per Liter
of Media
25
8 ml
4 ml
10 ml
4 ml
10 ml
15 ml
MEM essential amino acids (Gibco #320-1130)
MEM non-essential amino acids (Gibco #32-
1140)
MEM sodium pyruvate (Gibco #320-1360)
MEM Vitamins (Gibco #320-1120)
Penicillin-Streptomycin (Gibco #600-514 0)
Serine/ Asparagine/Glutamine mixture (see
recipe infra)
To prepare 2X McCoy's 5A medium (for plating), follow
the same procedure as for IX, except bring the volume only to
500 ml instead of 1 liter. Add the same volume of
30 supplements .
The Serine/Asparagine/Glutamine mixture is prepared
according to the following:
L-asparagine (Sigma #A-0884) 800 mg
L-serine (Sigma #S-4500) 420 mg
35
-87-
L-glutamine (Gibco #320-5030) 200 ml
1. Dissolve serine and asparagine in 450 ml double-distilled
H 2 0) , bring the volume to 500 ml and filter-sterilize
through a 0.2 urn filter
2. Add to this sterile mixture 200 ml of L-glutamine. Mix -
well and aliquot into 7.5 ml/tube. Store at -20 °C.
10
15
20
25
30
35
6.6.1.2. PREPARATION OF HUMAN 5637 URINARY
BLADDER CARCINOMA CELL LINE
CONDITIONED MEDIUM
The following procedure can be used to obtain medium
conditioned by the human 5637 urinary bladder carcinoma cell
line:
1. Thaw and start cells from frozen stocks, per "Quick Thaw"
protocol of Section 6.5, supra . Grow 5637 cells to
confluence in a 150 cm 2 flask containing 50 ml of the
following medium:
RPMI 164 0
glutamine (2 mM)
penicillin-streptomycin (10 ml/liter at
1000 units/ml)
10% fetal bovine serum (heat-inactivated)
2 . Incubate in an atmosphere of 5% C0 2 , with normal 0 2 , for
3-5 days; check daily.
3. Split the cells 1:20 into 20 X 150 cm 2 flasks with 50 ml
RPMI 1640 media (as above) .
4. Incubate for 7 days in 5% CO , normal O .
5. At 3-5 days, if desired, select 1 flask of cells to
prepare for freezing as a stock supply of cells. Freeze 10 6
cells/vial (1 ml) for liquid nitrogen storage, per the
protocol described in Section 6.4, supra .
6. At 7 days, collect cell medium into 20 X 50 cc centrifuge
tubes. Spin down cells and cell debris by centrifugation for
10 minutes at greater than or equal to 500 X g.
-88-
7. Pool the medium, filter-sterilize it using a 0.2 um
filter, and aliquot into 100 ml bottles. Store frozen at
less than 0°C (usually -20°C or -80°C) .
8. Assay stimulation activity of the medium by the CFU-GM
assay described in Section 6.6.1, e.g. , using human marrov
5 cells.
6.6.1.3. PREPARATION OF MURINE POKEWEED MITOGEN
SPLEEN CELL CONDITIONED MEDIUM
The following procedure can be used to obtain murine
10 pokeweed mitogen spleen cell conditioned medium (PWMSCM) , a
crude source of growth factors for use in hematopoietic
colony stimulation for mouse cells.
1. Obtain a single cell suspension of CBA/J mouse spleen
cells at a known cell concentration of greater than or equal
15 to 20 x 10 6 cells/ml. (Mice should be 5-7 weeks old).
2. Make a large volume of cell growth suspension as follows
CBA/J spleen cells 2 x 10 6 cells/ml
Heat-inactivated FCS 10%
20 Pokeweed mitogen 0.333% (1:300)
(Gibco #670-5360)
Iscove's modified Dulbecco's Remainder
media* + 3.024 gm NaHC0 3
(Gibco #78-5220)
25
* Preparation described infra in Section 6.6.2.3.
3. After mixing the above ingredients, place 50 ml of the
mixture in a 50 cm tissue culture flask, and incubate for 7
days at 37 'C in an atmosphere of 5% C0 2 .
30 4. After seven days, collect the conditioned media and
remove the cells by centrifugation at greater than or equal
to 500 X g at 4°C for 10-15 minutes.
5. Carefully remove the conditioned media from the tubes,
and filter-sterilize the media by passage through a 0.4 5 um
-89-
filter. Store the conditioned media in 50 ml polyethylene
tubes at -20°C.
The following assays have been used to quantify BFU-E-2
and BFU-E-1/CFU-GEMM. BFU-E-1 and BFU-E-2 are erythroid
progenitor cells that are operationally defined, and are not
proven to be physiologically distinct. The BFU-E-1 is
operationally defined as an early erythroid progenitor cell
capable of producing a colony of erythroid progeny cells in
semi-solid medium, upon stiumlation by erythropoietin, hemin
(optional) , and a burst-promoting factor* The BFU-E-2 is
operationally defined as a more mature erythroid progenitor
cell, capable of producing a colony of erythroid progeny
cells in semi-solid medium, upon stimulation by
erythropoietin and by hemin (optional) . BFU-E-1 colonies
tend to be larger than BFU-E-2 colonies.
For the BFU-E/CFU-GEMM assay, Iscove's modified
Dulbecco's medium (IMDM) was used, with methyl cellulose as
the semi-solid support medium. (This was in contrast to the
CFU-GM assay, where McCoy's medium was used, with bacto-agar
as the semi-solid support medium.)
The procedure was the following:
1. Obtain a single cell suspension of known concentration of
the appropriate type of cells.
2. Depending on the number of plates plated, the volume of
the culture mixtures will vary. As an example, we will make
a 3 ml mixture. In order to increase the mixture volume,
simply increase component volumes proportionately. In a 17 x
100 mm tube, mix the following components:
6.6.2.
BFU-E-2 AND BFU-E-1/CFU-GEMM ASSAY
30
3 ml
Methyl cellulose (2.1%)
Glutamine (200 mM, Gibco)
30
1.4 ml
ul
(2 mM)
35
-90-
10
— 2
2-mercaptoethanol (10 M)
(7 ul into 10 ml McCoy's 5A)
*Hemin (4 mM)
** Erythropoietin (20 units/ml)
FCS (not heat-inactivated)
Cells (at least 10 X desired)
***Iscove's Modified Dulbecco's
Medium (IMDM)
***GM Stimulator (if desired)
10
ul
75 ul
0.15 ml
0.9 ml
0.3 ml
0.135 ml
0.01 ml
(5 x 10 5 M)
- (0.1 mM)
(1 unit/ml)
(3.0%)
* Preparation described infra ; Lu, L. and Broxmeyer, H.E.,
1983, Exp. Hematol. 11 (8) : 721-729 .
15
20
25
**Note that there are different types of erythropoietin which
can be used; as an example, Hyclone erythropoietin has been
used in murine cell assays, and Toyobo erythropoietin has
been used in human cell assays. Purified recombinant
erythropoietin is commercially available ( e.g. , Amgen,
Thousand Oaks, CA) and may be used.
*** GM stimulators include but are not limited to various
factors which can be tested for colony stimulation, as
described for the CFU-GM assay. The volume of the GM
stimulator, and thus of the IMDM, may vary with the type of
stimulator used ( e.g. , mouse=PWMSCM; Human=5637 CM or
PHALCM) . Also note that IMDM is strictly a compensation
for the remaining volume of 3 ml.
30
35
3. Mix suspension thoroughly by vortexing and inversion of
tubes.
4. After allowing bubbles to rise from the mixture, place 1
ml mixture in each of two 10 x 35 mm culture plates
containing erythropoietin, hemin, and colony stimulating
factors, if so desired. Rotate the plates so that the
mixture coats the surface of the plates.
-91-
10
15
20
25
30
5. Place these 2 plates in a large 15 x 100 mm petri dish
along with a 10 x 35 mm humidifying dish containing about 1
ml 'of H 2 0. Replace the lid of the large dish.
6. Place the petri dish in an appropriate incubator for 14
days. Conditions of incubation are the same as described for
the CFU-GM assay of Section 6.6.1.
7. Remove plates from the incubator and score by observation
of colonies under an inverted or stereoscopic microscope.
In some cultures, the GM stimulator/burst-promoting
activity ( e.g. , medium conditioned by 5637 cells or PHALCM)
can be omitted; under these conditions, the assay detects a
more mature population of BFU-E (BFU-E-2) cells and few or no
CFU-GEMM cells.
6.6.2.1. PREPARATION OF 2.1% METHYL CELLULOSE
The 2.1% methylcellulose, for use in the BFU-E/CFU-GEMM
assay, was prepared as follows:
Stock solution ;
2.1% Methocel (Dow Chemical Co.) 21 grams
Boiling water 500 ml
2x IMDM 500 ml
Procedure :
35
The gram weight of methyl cellulose is put into a
sterile 3 liter Erlenmeyer flask (having a sterile stopper)
containing a sterile magnetic flea on a large magnetic
stirrer. To prevent as little frothing as possible, stirring
is initiated while 500 ml of sterile boiling distilled H 2 0 is
gently poured down the sides of the flask. Stirring contin-
ues at room temperature until the flask gradually cools (this
may take an hour) . When the flask is no longer hot to the
touch, 500 ml of 2X IMDM, which had been allowed to come to
room temperature , is added to the flask without frothing.
The flask is stoppered and transferred to the cold room (4°C)
-92-
where stirring continues for 48 hours. The solution is then
sterilely aliquoted into sterile 100 ml bottles. The bottles
are stored frozen for up to 6 months (protected from light) .
6.6.2.2. PREPARATION OF HEM IN
The hemin, for use in the BFU-E/CFU-GEMM assay, was pre-
pared as follows:
2 60 mg Hemin (Eastman Kodak #22 03)
4 ml 0.5 M NaOH
\y 5 ml Tris buffer, 1 M, pH 7 . 8 (approximately
10
9.5 parts acid to 3 parts base)
Bring to 100 ml with double-distilled H 2 0.
1. Dissolve hemin in NaOH completely before adding Tris
buffer and H 2 0.
2. After adjusting the volume to 100 ml, filter-sterilize by
passage through an 0.45 um filter, and store in 2-3 ml ali-
quots at -20 °C.
15
6.6.2.3. PREPARATION OF ISCOVE'S
MODIFIED DULBECCO'S MEDIUM
20 IX Iscove's Modified Dulbecco's Medium (IMDM) , for use
in the BFU-E/CFU-GEMM assay, was prepared as follows:
1. Measure out 5% less water (deionized, distilled) than
desired total volume of medium, using a mixing container that
is as close to the final volume as possible.
25 2. Add powder medium (Gibco Laboratories, Formula No. 78-
5220) , to water with gentle stirring at room temperature (do
not heat water) .
3. Rinse out the inside of the package, to remove all traces
of the powder.
30 4. Add 3.024 grams of NaHC0 3 per liter of medium.
5. Dilute to the desired volume with water. Stir until
dissolved.
6. Do not adjust pH. Keep container closed until medium is
filtered.
35
-93-
7. Sterilize immediately by Nalgene filtration.
To prepare 1 liter of 2X liquid medium, follow the above
procedure, except use 2 envelopes of powder instead of one,
and 6.048 gm NaHC0 3 .
6.6.3. STEM CELL COLONY FORMING UNIT ASSAY
The assay used for stem cell (S-cell) quantitation does
not directly assay self -renewal, but instead assays for the
ability to generate secondary multilineage colonies on
replating. This assay is done essentially the same as the
BFU-E/ CFU-GEMM assays, except that cultures are scored after
21-28 days of incubation rather than after 14 days (for BFU-E
and CFU-GEMM) . The drug 4-hydroperoxycyclo-phosphamide (4HC)
appears to spare immature progenitors at the expense of
mature progenitors, and may be useful for pretreating cells
before assay. Factors which can be tested for increasing the
self-renewal ability of S-cells in vitro (thus increasing
assay efficiency) include but are not limited to hemin,
oxygen tension (Smith, S. and Broxmeyer, H.E., 1986, Brit. J.
Haematol. 63:29-34), superoxide dismutase, glucose oxidase,
IL-3, GM-CSF, G-CSF, M-CSF, erythropoietin, IL-1, IL-4 , etc.
6.6.4. ASSAY OF THE PROLIFERATIVE STATUS
OF STEM AND PROGENITOR CELLS
25 The proliferative status of stem and progenitor cells
can be measured by a high specific activity tritiated
3
thymidine ( HTdr) kill (or suicide) technique, carried out as
follows:
1. In two small 12 x 75 mm polystyrene tubes, place the
30 appropriate volume of stock cell suspension containing 2-3
times the number of cells required for plating. (For bone
marrow, 2-3 X 10 6 cells and for spleen, 15-20 X 10 6 cells.
For cord blood: 2-3 x 10 6 (approx. ) cells.) Label them a and
b.
-94-
2. Pellet the cells by centrif ugation at 200-400 X g at 4°C
for 10 minutes.
3. Carefully remove and discard the supernatant.
4. Add 0.5 ml of McCoy's 5A medium supplemented as
prescribed in Section 6.6.1.1, supra , and with FCS at 10%
v/v.
5. To tube b, add 50 uCi of 3 HTdr (New England Nuclear,
#NET-027X Thymidine, [methyl- 3 H] -20 . 0 Ci/mmol; 5.0 mCi/5.0 ml
H 2 0) . As a control, to tube a, add 50 ul of McCoy's 5A
medium.
6. Place cap back on tubes and gently vortex in order to
resuspend cells.
7. Place the tubes in a tray also containing H 2 0, in an
incubator with an atmosphere of 5% C0 2 , and a temperature of
37°C, for 20 minutes.
8. Add 0.5 ml (2.5 mg) of ice cold (4°C) 'cold*' (nonradio-
active) thymidine (Sigma #T-9250) at 5 mg/ml to each tube,
and vortex lightly. Add an additional 2 ml of ice cold
McCoy's 5 A medium to each tube.
9. Pellet cells by centrif ugation at 200-400 X g at 4°C for
10 minutes.
10. Aspirate the supernatant into an appropriate container
(one used for radioactive disposal) , and resuspend the cells
with 2 ml cold medium. Repeat step #10.
11. Aspirate the supernatant into an appropriate container.
Resuspend with McCoy's 5A containing 10% FCS to a volume
where the cell concentration is at least 10 fold greater than
the plating concentration.
12. Keep cells on ice until ready to plate.
13. Plate and carry out colony forming assays as described
supra in sections 6.6.1 through 6.6.3.
35
# •
-95-
6.7. RECOVERY AFTER FREEZE-THAWING
OF HUMAN HEMATOPOIETIC PROGENITOR
CELLS DERIVED FROM CORD BLOOD
The results of progenitor cell assays after freeze-
thawing were compared to results of the same assays obtained
5 before f reeze-thawing, in order to assess the recovery of
hematopoietic progenitor cells from human cord blood after
the f reeze-thawing process. Eight cord blood samples,
obtained as described in Section 6.1, supra , and separated by
use of Ficoll-Hypaque, were analyzed. The results are shown
n in Table V.
15
20
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-98-
As shown in Table V, the average % survival after freeze-
thawing was 36,1, 65.6, 65.4, 45.8, 44.6, and 30.5, respect-
ively, for nucleated cells, day 7 CFU-GM, day 14 CFU-GM,
BFU-E-2, BFU-E-1, and CFU-GEMM. There was a range of varia-
bility in recovery rates.
It should be noted that the data presented in Table V
reflects cell losses incurred during Ficoll-Hypaque
separations and procedures for DMSO removal, two steps which
are omitted in a preferred embodiment of the invention (NB:
DMSO should be removed before colony assays if such are
10 desired to be carried out) .
6.8. CALCULATIONS OF THE RECONSTITUTING
POTENTIAL OF CORD BLOOD
The following discussion demonstrates that individual
15 collections of cord blood (such as described in Section 6.1)
contains sufficient hematopoietic stem and progenitor cells
to repopulate the hematopoietic system of an individual.
A survey of published reports indicates that the number
of CFU-GM infused for autologous bone marrow reconstitution
20 in human patients, can be relied on as an indicator of the
potential for successful hematopoietic reconstitution
(Spitzer, G., et al., 1980, Blood 55(2): 317-323; Douay et
al., 1986, Exp. Hematol. 14:358-365). By standardizing
published data by patient weight, and assuming a patient
25 weight of 150 pounds (67.5 kilograms), the calculated number
of CFU-GM needed for successful hematopoietic reconstitution
using autologous bone marrow cells ranges from 2-425 x 10 4 ,
with faster recovery noted using greater than 10 x 10 4 CFU-
GM.
30 The data presented in Table III, supra , for 81 cord
blood collections, analyzed for day 14 CFU-GM count, shows a
range of 0-109 x 10 4 CFU-GM per Ficoll-Hypaque-separated
individual blood collections. Seventy samples contained
greater than or equal to 2 x 10 4 CFU-GM, while thirty samples
35
10
15
20
25
30
-99-
as
contained greater than or equal to 10 x 10 4 CFU-GM. It
should be emphasized that this data is derived from Ficoll-
Hypaque-separated cells obtained by either gravity drainage
from the cord or needle aspiration from the delivered
placenta. In a preferred embodiment of the invention, where
vhQle blood is both frozen and infused for therapeutic use,
losses due to Ficoll-Hypaque separation can be avoided (see
Table IV and Section 6-3.1 infra for data on cell losses
incurred during Ficoll-Hypaque separations). In addition,
mentioned in Section 6.1, supra , in recent blood collections,
we have been able to obtain volumes approximately twice as
large as shown in Figure 2 or described in Table III, by
using needle aspirations from the delivered placenta at the
root of the placenta and in the distended surface veins, in
combination with cord drainage. Furthermore, an adjustment
of the collection protocol to provide for immediate cord
clamping upon delivery should result in receipt of greater
blood collection volumes (See Yao, A.C., et al., October 25,
1969, Lancet: 871-873, wherein collected neonatal blood,
obtained by drainage from the umbilical cord and from the
delivered placenta, averaged 126.6 ml volume when the
umbilical cord was clamped in less than 5 seconds after
birth) . Thus, although an analysis of the data of Table III
should be adjusted for expected losses during f reeze-thawing
(which losses, however, should not exceed 35%), there should
be sufficient cord stem and progenitor cells per collection
sample to successfully effect hematopoietic reconstitution.
Furthermore, the reconstituting capacity of cord blood
hematopoietic cells may be higher than that of an equal
number of bone marrow cells. Colonies derived from cord
blood cells are usually larger in size than those derived
from adult bone marrow.
35
-100-
6.9. IN VITRO CULTURE CONDITIONS FOR
HEMATOPOIETIC STEM AND PROGENITOR CELLS
Culture conditions for the growth in vitro of
hematopoietic progenitor cells from human cord blood have
been described in Smith, S. and Broxmeyer, H.E., 1986,
British Journal of Hematology, Vol. 63, pp. 29-34, which is
incorporated by reference herein in its entirety. Culture
media was composed of the following ingredients:
RPMI 1640 media (Gibco Laboratories, Grand Island, NY)
10 6 M hydrocortisone (Sigma, St* Louis, MO)
5 ug/ml Vitamin D 3 (U.S. Biochemical Corp., Cleveland,
OH)
20% fetal calf serum, heat-inactivated (Hyclone
Laboratories, Logan, UT)
2 gm/1 NaHC0 3 (Fisher Scientific Co., Fair Lawn, NJ)
100 U/ml Penicillin
100 ug/ml Streptomycin
0.2 5 ug/ml Fungizone
Various conditions and factors can be tested for any
effect increasing the self-renewal ability of stem cells in
vitro. These include but are not limited to oxygen tension
(see Smith and Broxmeyer, 1986, Br. J. Hematol . 63:29-34,
incorporated by reference herein) , superoxide dismutase
(Sigma Chemical Co., St. Louis, Mo.), glucose oxidase (Sigma
Chemical Co.), and combinations of various colony stimulating
factors, namely interleukin-3 (IL-3) , granulocyte-macrophage
(GM) -colony stimulating factor (CSF) , granulocyte (G)-CSF,
macrophage (M) -CSF (CSF-1) , erythropoietin, IL-1, and IL-4 (B
cell growth factor) .
6.10. MOUSE DISSECTION PROTOCOLS
Mouse bone marrow and spleen are valuable sources of
murine hematopoietic stem and progenitor cells for model
-101-
studies testing new and/or improved protocols for use with
the human neonatal stem and progenitor cells of the present
invention. Procedures for dissection of mouse bone marrow
and spleen are described in Sections 6,10,1, and 6.10.2,
respectively.
6.10.1. BONE MARROW DISSECTION
The following procedure can be used to obtain a murine
bone marrow cell suspension:
1. Sacrifice mouse as prescribed by cervical-thoracic
dislocation.
2. Inside a laboratory hood, soak the mouse with 70% ethanol
(to avoid microbial contamination) , completely wetting
the fur.
3. Snip through the skin, and peel the skin down to the hip
by holding the foot with either forceps that have been
soaked in 7 0% ethanol, or with fingers, and pulling the
skin with forceps.
4. With sterile (alcohol-treated) forceps and scissors, cut
away as much muscle tissue as possible to expose the
femur.
5. Remove the tibia from the femur by cutting through the
knee cartilage/ joint . Discard the tibia.
6. Remove the femur from the body by placing the sharp edge
of a scissors on the anterior side of the hip joint, and
pulling the femur in the opposite direction against the
scissors, so that the scissors fits in the fold. Snip
through the joint.
7. Remove the knee end of the femur first, by snipping just
the end with a scissors. Remove the hip end from the
femur by the same method.
8. With a 10 cc syringe containing 5 ml media (McCoys 5A IX)
and a 27 gauge needle, place the needle in the bone cav-
ity via the hip end of the bone.
-102-
10.
15
20
25
30
9* Flush the marrow from the bone by forcing media into the
cavity with the syringe, while holding the bone and
syringe over a 17 x 100 mm tube,
10. After both femurs have been evacuated, break up clumps
with a 10 cc syringe and a 23 gauge needle.
11. Pellet the cells by centrifugation at 400 X g (1500 rpm
in a Beckman TJ-6R rotor) for 10 minutes at 4°C.
12. Aspirate the supernatant and discard it.
13. Resuspend the cells with 10 ml McCoys 5A media and a
pipette, and repeat steps 11 and 12.
14. Resuspend the cells with 10 ml McCoy's 5A media with a
pipette, and count the cells (with a hemocytometer) .
6.10.2. SPLEEN DISSECTION
The following procedure can be used to obtain a murine
spleen cell suspension:
1. Sacrifice mouse as prescribed by cervical-thoracic dis-
location.
2. Inside a laboratory hood, soak the mouse with 70% ethanol
(to avoid microbial contamination) , completely wetting
the fur.
3 . Place the mouse on its abdomen and snip through its
left side skin with a sterile scissors and forceps.
4. Lift the peritoneum with the forceps, and snip through to
the abdominal cavity.
5. With the spleen in view, remove it and place it in a 60 X
100 mm dish containing 5-7 ml media.
6. Place the spleen in a sterile homogenizing screen, in the
dish, and snip it into small pieces.
7. With the plunger of a 10 cc syringe, gently work the
tissue through the screen into a dish containing media.
8. Transfer the cell suspension from the dish to a tube.
Rinse the plate with 3 ml media and pool.
-103-
9. Resuspend small pieces by transferring the cell
suspension from the tube to a 10 cc syringe, and passing
it through a 23 gauge needle twice .
10. Pellet the cells by centrif ugation at 400 X g (1500 rpiu)
for 10 minutes at 4*C.
5
11. Aspirate the supernatant and discard it.
12. Resuspend the cells with 10 ml McCoy's 5A media and a
pipette, and repeat steps 10 and 11.
13. Resuspend the cells with 10 ml McCoy's 5A media, and
count the cells (with a hemocytometer) .
6.11. HEMATOPOIETIC RE CONST I TUT I ON OF
ADULT MICE WITH SYNGENEIC FETAL
OR NEONATAL STEM CELLS
The experiments described in the examples sections infra
15 demonstrate the hematopoietic reconstitution of adult mice
with syngeneic or Tla-congenic stem cells of fetal or
neonatal blood.
A key reference and source of citations for use in
animal model studies, which describes standards for experi-
2Q mental irradiation, of mice and other mammals, at the level
causing 100% mortality from hematopoietic failure, and
prevention of such mortality by hematopoietic reconstitution
(with bone marrow cells), is: Balner, H. Bone Marrow
Transplantation and Other Treatment after Radiation Injury,
25 Martinus Nijhoff Medical Division, The Hague, 1977, which is
incorporated by reference herein.
6.11.1. HEMATOPOIETIC RECONSTITUTION OF LETHALLY-
IRRADIATED MICE WITH STEM CELLS
IN BLOOD OF THE NEAR-TERM FETUS
30 The examples herein described demonstrate that stem
cells in blood of the near-term fetus are able to reconsti-
tute the hematopoietic system of lethally-irradiated mice.
The irradiated mice were ten (B6 X A-Tla b )F ]L hybrid
males, aged seven weeks. The mice were exposed to 862.8 rads
-104-
at a radiation dose of 107.85 rad/min for 8 minutes with a
137
Cs source. This dose constitutes the LD100/30 days, i.e.,
the minimum or near-minimal Lethal Dosage causing 100%
mortality within a 30-day post-irradiation period. Use of
the 3 0-day survival endpoint is standard because hematopoie-
tic reconstitution is deemed sufficient by that time, and any
later mortality is therefore attributable to causes other
than hematopoietic failure.
Blood was collected from five near-term (B6-Tla a X A)
hybrid fetuses, delivered by Caesarian section from one
mother. In this experiment, near-term fetuses were used
instead of neonates in order to ensure microbial sterility.
The genetics of donor and recipient mice provides complete
histocompatibility except for a segment of chromosome 17
bearing the Tla marker gene. All mice were maintained
previously and throughout on acidified drinking water to
eradicate pseudomonas and similar infective organisms.
As a restorative treatment, three mice each received
0.17 ml heparinized whole fetal blood (made up to a total
volume of approximately 0.2 ml by adding M199 medium with
penicillin and streptomycin added) by intravascular injection
into a peri-orbital vein of the eye, within two hours of
irradiation. The results (Table VI) demonstrated the
resultant survival of mice reconstituted with fetal blood
stem cells, in contrast to the observed death of mice which
had undergone no restorative treatment.
30
35
-105-
TABLE VI
HEMATOPOIETIC RECONSTITUTION OF LETHALLY-
5 IRRADIATED ADULT MICE WITH STEM CELLS
IN BLOOD OF THE NEAR-TERM FETUS
3 0-day Sur-
Group Day of Death vival Rate*
(1) Treated 14 2/3**
10 (2) Controls; no restorative 11, 12, 12, 0/7
treatment but conditions 13, 13, 15,
otherwise identical 15
15
20
25
30
* All 3 0-day survivors were normally healthy over prolonged
periods of observation, displaying the typical post-
irradiation graying of the coat, and would doubtless have
experienced an approximately normal life-span, as is
typical of reconstitution with syngeneic or near-syngeneic
cell donors*
** Later typing for the Tla marker by cytotoxicity assay of
thymocytes (Schlesinger , M. , et al., 1965, Nature
206:1119-1121; Boyse, E.A., et al., 1964, Methods in
Medical Research 10:39) established repopulation by donor
cells of the injected blood.
6.11.2. HEMATOPOIETIC RECONSTITUTION OF MICE
WITH A LESSER VOLUME OF NEAR-TERM FETAL
BLOOD BUT NOT WITH ADULT BLOOD
The examples herein described demonstrate that a defined
volume of near-term fetal blood contains adequate hematopoi-
etic stem cells to effectively reconstitute the hematopoietic
system of lethally-irradiated mice, while the same volume of
adult blood will not effect successful reconstitution.
35
10
15
20
#
-106-
The irradiated mice were 20 (B6 x A-Tla ) F hybrid males
aged 7 weeks, and 10 (B6 x A-Tla ) F females aged 7 weeks.
The mice were exposed to 862.8 rads at a radiation dose of
107.85
days) .
13 7
107.85 rad/min for 8 minutes with a Cs source (LD100/30
Blood was collected from eight near-term (B6-Tla x A) F^
hybrid fetuses, delivered by Caesarian section from one
mother. In this experiment, near-term fetuses were used
instead of neonates in order to ensure microbial sterility.
The genetics of donor and recipient mice provides complete
histocompatibility except for a segment of chromosome 17
bearing the Tla marker gene. All mice were maintained
previously and throughout on acidified drinking water to
eradicate pseudomonas and similar infective organisms.
As a restorative treatment, 10 mice received 0.02 ml
heparinized whole fetal blood per mouse (made up to a total
volume of 0.22 ml by adding M199 medium with penicillin and
streptomycin added) , and 10 mice each received 0.02 ml adult
whole blood identically treated, by intravascular injection
into a peri-orbital vein of the eye, within 2 hours of
irradiation. Control mice received no restorative treatment.
The results (Table VII) demonstrated that stem cells in a
defined volume of fetal blood can successfully reconstitute
the hematopoietic system, while cells in an equal volume of
adult blood cannot.
25
30
35
-107-
10
15
30
35
TABLE VII
SUCCESSFUL HEMATOPOIETIC RECONSTITUTION
WITH A DEFINED VOLUME OF NEAR-TERM
FETAL BLOOD BUT NOT WITH ADULT BLOOD
30-day Sur-
Group Day of Death vival Rate*
(1) Treated with fetal blood 10,12, 12, 5/10**
14, 14
(2) Treated with adult blood 11, 11, 12, 0/10
12, 12, 13,
14, 14, 15,
15
(2) Controls: no restorative 9, 10, 10, 0/10
treatment but conditions 11, 11, 12,
otherwise identical 12, 12, 15,
23
* All 30-day survivors were normally healthy over prolonged
periods of observation, displaying the typical post-
20 irradiation graying of the coat, and would doubtless have
experienced an approximately normal life-span, as is
typical of reconstitution with syngeneic or near-syngeneic
cell donors.
25 ** Later typing for the Tla marker by cytotoxicity assay of
thymocytes (Schlesinger , M. , et al., 1965, Nature
206:1119-1121; Boyse, E.A., et al., 1964, Methods in
Medical Research 10:39) established repopulation by donor
cells of the injected blood.
-108-
6-11.3. HEMATOPOIETIC RECONSTITUTION WITH
BLOOD OF NEWBORN MICE IN VOLUMES
AS LOW AS TEN MICROLITERS
The examples herein described demonstrate that the stem
cells in a volume of neonatal blood as low as 10 microliters
5 can reconstitute the hematopoietic system of lethal ly-
irradiated mice.
The irradiated mice were 20 (B6 x A-Tla b )F 1 hybrid males
aged 8-12 weeks. The mice were exposed to 862.8 rads at a
radiation dose of 107.85 rad/min for 8 minutes with a 137 Cs
1Q source (LD100/30 days) .
Blood was collected by cervical section from eighteen
(B6-Tla a x A)F 1 hybrid neonates, less than 24 hours old. As
a restorative treatment, 5 mice received 0.04 ml heparinized
whole neonatal blood per mouse (made up to a total volume of
15 approximately 0.2 ml by adding M199 medium with penicillin
and streptomycin added), (Group 1); 5 mice each received 0.02
ml (Group 2); 5 mice each received 0.01 ml (Group 3); and 5
mice received no further treatment (Group 4, radiation
control) . Treatment was by intravascular injection into a
2Q peri-orbital vein of the eye.
The genetics of donor and recipient mice provides
complete histocompatibility except for a segment of chromo-
some 17 bearing the Tla marker gene. All mice were main-
tained previously and throughout on acidified drinking water
25 to eradicate pseudomonas and similar infective organisms.
The results in Table VIII show that stem cells in
extremely small neonatal blood volumes (down to 10 ul) were
able to reconstitute the hematopoietic system.
35
/b?
10
15
-109-
TABLE VIII
SUCCESSFUL HEMATOPOIETIC RECONSTITUTION
WITH NEONATAL BLOOD VOLUMES
AS LOW AS TEN MICROLITERS
30-day Sur-
Group Day of Death vival Rate*
(1) Treated with 0*04 ml 12 4/5**
neonatal blood
(2) Treated with 0.02 ml 14, 18 3/5
neonatal blood
(3) Treated with 0.01 ml 12, 12, 14, 1/5
neonatal blood 14
(4) Controls: no restorative 5, 6, 9, 10, 0/5
treatment but conditions 11
otherwise identical
* All 30-day survivors were normally healthy over prolonged
periods of observation, displaying the typical post-
20 irradiation graying of the coat, and would doubtless have
experienced an approximately normal life-span, as is
typical of reconstitution with syngeneic or near-syngeneic
cell donors.
25 ** Later typing for the Tla marker by cytotoxicity assay of
thymocytes (Schlesinger , M. , et al., 1965, Nature
206:1119-1121; Boyse, E.A., et al., 1964, Methods in
Medical Research 10:39) established repopulation by donor
cells of the injected blood.
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6.11.4. HEMATOPOIETIC RE CONST I TUT I ON
WITH BLOOD OF NEWBORN MICE IN
VOLUMES OF 10 OR 15 MICROLITERS
The examples herein described demonstrate that the stem
cells in a volume of neonatal blood as low as 10 or 15
microliters can reconstitute the hematopoietic system of
lethally-irradiated mice.
The irradiated mice were 15 male and 5 female (B6 x A-
Tla )F 1 hybrids aged 10-12 weeks. The mice were exposed to
862.8 rads at a radiation dose of 107.85 rad/min for 8
minutes with a 137 Cs source (LD100/30 days) •
Blood was collected by cervical section from fourteen
(B6 x A-Tla b )F 1 hybrid neonates, less than 24 hours old. As
a restorative treatment, 10 mice received 0.015 ml
heparinized whole neonatal blood per mouse (made up to a
total volume of approximately 0.2 ml by adding M199 medium
with penicillin and streptomycin added), (Group 1); 5 mice
each received 0.01 ml (Group 2); and the 5 female mice
received no further treatment (Group 3, radiation control).
Treatment was by intravascular injection into a peri-orbital
vein of the eye. The donor and recipient mice were
genetically identical, and thus completely histocompatible .
All mice were maintained previously and throughout on
acidified drinking water to eradicate pseudomonas and similar
infective organisms .
The results shown in Table IX reveal that stem and
progenitor cells in neonatal blood volumes of 10 or 15
microliters were able to reconstitute the hematopoietic
system.
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TABLE IX
SUCCESSFUL HEMATOPOIETIC RE CONSTITUTION
WITH NEONATAL BLOOD VOLUMES
OF 10 OR 15 MICROLITERS ,
30-day Sur-
Group Day of Death vival Rate*
(1) Treated with 0.015 ml 12, 12, 12, 4/10
neonatal blood 13, 13, 13
(2) Treated with 0.01 ml 12, 16 3/5
neonatal blood
(4) Controls: no restorative 12, 13, 14, 0/5
treatment but conditions 17, 22
otherwi se ident ica 1
All 3 0-day survivors were normally healthy over prolonged
periods of observation, displaying the typical post-
irradiation graying of the coat, and would doubtless have
experienced an approximately normal life-span, as is
typical of reconstitution with syngeneic or near-syngeneic
cell donors.
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6.12. HEMATOPOETIC RECONSTITUTION FOR
TREATMENT OF FANCONI 9 S ANEMIA
In the example herein, we describe a procedure
which was carried out to effect the hematopoietic
reconstitution of a patient by allogeneic peripheral blood
stem cell infusion, for treatment of the genetic anemia
Fanconi ' s syndrome .
The patient was a 5 year old white male* child with
Fanconi 's anemia. The patient was first noted to be
pancytopenic at 24 months of age. He was subsequently
confirmed to have Fanconi 's anemia by diepoxybutane-induced
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chromosomal breakage assay (Auerbach, A.D., et al., 1979, Am.
J - Hum. Genet. 31 ( 1) : 77-81) . The patient had undergone no
interventional therapy other than Danazol administration. He
cells and once with platelets) .
The source of neonatal blood for the hematopoietic
reconstitution was a female sibling, who was compatible with
the patient for HLA and red cell antigens. By study of the
in utero sibling's fibroblasts obtained at amniocentesis, the
sibling was found to be a four antigen match. The chromosome
breakage test (Auerback, A.D., et al, 1979, Am. J. Hum.
Genet. 31(1):77-81) demonstrated that the female sibling did
not suffer from Fanconi's anemia.
Approximately 150 ml neonatal blood was collected from
the umbilical cord and placenta of the sibling at birth, and
was diluted 1:1 in sterile pyrogen-free saline containing
DMSO to a final concentration of 10% DMSO. The blood was
then shipped under sterile conditions by overnight mail to a
processing site, where it was frozen slowly, in transplant-
ation bags, in a time-freezing apparatus, and was stored in
liquid nitrogen.
Prior to freezing, a sample of the diluted blood was
assayed to determine hematopoietic progenitor cell counts as
described in Section 6.6, supra . The results are shown in
Table X.
had undergone transfusions on two occasions (once with red
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TABLE X
HEMATOPOIETIC PROGENITOR CELLS IN DONOR NEONATAL BLOOD
5 Before Freezing Cord Blood Placental Blood Total
Total Nucleated
Cells 1.05 x 10 9 1.42 x 10 1.2 x 10 9
Granulocyte-
Macrophage
Q Progenitors
(CFU-GM) 2.23 X 10^ 0.13 X 10° 2.46 x 10
Erythroid Pro-
genitors
(BFU-E) 3.72 X 10 b 0.25 X 10 3.97 X 10 5
15 Multipotential
Progenitors
(CFU-GEMM) 3.57 x 10 0.28 x 10 0.39 X 10 4
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After a test freeze-thaw on a sample of the neonatal
blood (1 month frozen) , recovery of viable hematopoietic
progenitor cells was as follows (as assessed by in vitro
hematopoietic progenitor cell colony assays as described in
Section 6.6): 100% of CFU-GM, 45% of BFU-E, and 75% of CFU-
GEMM.
The patient was conditioned for hematopoietic
reconstitution by methods similar to those which have been
used for conditioning nonconstitutional aplastic anemia
(Gluckman, E., et al . , 1984, in Aplastic Anaemia, Stem Cell
Biology and Advances in Treatment, Young, N.S., et al., eds.
Alan R. Liss, Inc., New York, pp. 325-333; incorporated by
reference herein) except that dosages of chemoradiotherapy
were decreased. The patient was administered cytoxin®
(cyclophosphamide) intravenously at a dosage of 5 mg/kg/day
at six, five, four, and three days prior to neonatal blood
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infusion, for a total of 2 0 mg/kg. One day prior to
infusion, the patient was subjected to thoraco-abdominal
irradiation with 500 rads and administered Cyclosporin A.
The frozen blood sample was shipped, under liquid
nitrogen, to the site of patient treatment, where it was
thawed in a water bath. Approximately 3 00 ml of the thawed
blood sample was infused intravenously into the patient for
treatment of the Fanconi's anemia.
6.13. FLOWCHART: DESCRIPTION OF A SERVICE
In a particular embodiment of the invention, the isola-
tion and preservation of neonatal hematopoietic stem and
progenitor cells is envisioned as a service offered to each
prospective cell donor, which can comprise the steps listed
below. The description is meant for illustrative purposes
only, in no way limiting the scope of the invention.
1 . Contact
Initial contact is made between an expectant
mother (client) and the obstetrician, who arranges the ser-
vice.
2. Blood Collection
In the obstetrical ward, after the infant has been
delivered and separated from the cord in the usual way, blood
is drawn from the cord into a specially designed receptacle,
which is sealed and placed in a customized shipping con-
tainer, together with a data-form, completed by a member of
the obstetrical team, giving details of the birth.
3 . Transport
Once daily, an overnight freight carrier collects
the shipping containers from the obstetrical wards, and
transports them to processing headquarters by 10:30 A.M. the
following day.
4. Registration
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Upon receipt at headquarters, each container is
catalogued . The blood enters the laboratory for processing
(optional) .
5. Blood Processing (optional)
The cells are separated, and the white cells,
which include the stem and progenitor cells, are retained for
storage,
6. Testing
The separated cells undergo routine testing (see
Section 5.1.2, supra ) . In exceptional cases, special testing
may be indicated to determine whether the sample is contamin-
ated, e.g. , by maternal blood. Samples may be rejected for
reason of contamination or other causes.
7. Packaging and Labeling
Cells from each accepted sample are dispensed into
standard freezing vials (cryules) and labeled in conventional
and computer-generated characters.
The cells of each individual are allocated to four
cryules, two of which are assigned for storage to one freezer
and two to another, independently-serviced, freezer. A fifth
cryule contains cells set aside for testing of identity,
viability, and function, when withdrawal of cells is required
for therapy.
Labels are printed by computer, using a special
printer, on silk, which withstands immersion in liquid
nitrogen. The label data include the registration number, in
machine readable and human readable characters, date of
freezing, cryule number (1-4, 5) and freezer assignment (A
and B) .
8. Freezing and Storage
The cryules are subjected to slow freezing, and
assigned to two separately maintained liquid nitrogen refri-
gerators .
9 . Permanent Records
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The entire preparative history is entered into the
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permanent records, including location within cryostorage
modules. For example, data input for each donor for main-
tenance in the computer records can comprise:
Registration number
Name
Sex
Date of birth
Place of birth (hospital identification)
Birth certificate number
Name of mother
Date of receipt of cells
Date of freezing
Freezer positions
Obstetrical data
(a) special circumstances of birth
(b) if twin, registration number of co-twin
(c) any health disorder of the mother-
Test results
(a) differential cell counts
(b) bacterial cultures
(c) other tests performed
10. Notification to Client
The client is notified of the registration number,
for preservation with child's documents, and is asked for
information not available at the time of birth (given name,
birth number) , for inclusion in permanent records.
11. Withdrawal of Cells for Clinical Use
Requests for cells for treatment of the donor are
made on behalf of the donor by a suitably accredited physi-
cian affiliated with an appropriate hospital unit. Cells are
withdrawn from the cell bank and matched for identity with
the recipient. The cells are also tested for viability and
microbial contamination, and quantified in terms of stem
cell, progenitor cell, and other categories. Further tests
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are conducted as required. Cells and an accompanying report
are delivered to the medical institution designated by the
physician. An appropriate notation is entered in the perma-
nent records.
It is apparent that many modifications and variations of
this invention as hereinabove set forth may be made without
departing from the spirit and scope thereof. The specific
embodiments described are given by way of example only and
the invention is limited only by the terms of the appended
claims .
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